Provider Demographics
NPI:1689754798
Name:REPRODUCTIVE IMAGING & ANTENATAL TESTING, LLC
Entity Type:Organization
Organization Name:REPRODUCTIVE IMAGING & ANTENATAL TESTING, LLC
Other - Org Name:ST. LUKE'S HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, PHYSICIAN PRACTICE MGMT.
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SONNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-576-2490
Mailing Address - Street 1:232 S WOODS MILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3417
Mailing Address - Country:US
Mailing Address - Phone:314-469-3990
Mailing Address - Fax:314-542-0791
Practice Address - Street 1:226 S WOODS MILL RD
Practice Address - Street 2:SUITE 62 WEST
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3662
Practice Address - Country:US
Practice Address - Phone:314-469-3990
Practice Address - Fax:314-542-0791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-16
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7824174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODE1382OtherRAIL ROAD MEDICARE