Provider Demographics
NPI:1831147321
Name:MAGNETIC IMAGING OF BELLEVILLE, LTD
Entity Type:Organization
Organization Name:MAGNETIC IMAGING OF BELLEVILLE, LTD
Other - Org Name:HEALTHSOUTH DIAGNOSTIC CENTER OF BELLEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-685-5075
Mailing Address - Street 1:7 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5958
Mailing Address - Country:US
Mailing Address - Phone:618-277-0600
Mailing Address - Fax:618-277-0609
Practice Address - Street 1:7 CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5958
Practice Address - Country:US
Practice Address - Phone:618-277-0600
Practice Address - Fax:618-277-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200019Medicare ID - Type UnspecifiedIDTF