Provider Demographics
NPI:1689628869
Name:WATSON IMAGING CENTER
Entity Type:Organization
Organization Name:WATSON IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOODHOPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-282-0184
Mailing Address - Street 1:2151 JANUARY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2935
Mailing Address - Country:US
Mailing Address - Phone:314-645-4900
Mailing Address - Fax:
Practice Address - Street 1:3915 WATSON RD
Practice Address - Street 2:STE. LL2
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1251
Practice Address - Country:US
Practice Address - Phone:314-781-9711
Practice Address - Fax:314-781-9768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MONA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
852265OtherFIRST HEALTH
2053OtherBCBSMO
9011OtherHCUSA
235650OtherHEALTHLINK
10843OtherESSENCE
436640OtherFOCUS
8352036OtherAETNA
1027473OtherAMERICAN SPECIALTY NETWOR
1610036OtherUHC
2788OtherGROUP HEALTH PLAN
7363390OtherCIGNA
7363390OtherCIGNA
7363390OtherCIGNA