Provider Demographics
NPI:1710971080
Name:SPECIALIZED IMAGING SERVICES, INC.
Entity Type:Organization
Organization Name:SPECIALIZED IMAGING SERVICES, INC.
Other - Org Name:DIAGNOSTIC HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-242-8500
Mailing Address - Street 1:9785 MACKENZIE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-5438
Mailing Address - Country:US
Mailing Address - Phone:314-544-3536
Mailing Address - Fax:
Practice Address - Street 1:9785 MACKENZIE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-5438
Practice Address - Country:US
Practice Address - Phone:314-544-3536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO711430504Medicaid
MO470000848Medicare PIN
MO711430504Medicaid