Provider Demographics
NPI:1871689505
Name:RADIOLOGIC IMAGING CONSULTANTS, LLP
Entity Type:Organization
Organization Name:RADIOLOGIC IMAGING CONSULTANTS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-947-4480
Mailing Address - Street 1:220 COMPASS POINT DR
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301
Mailing Address - Country:US
Mailing Address - Phone:636-947-4480
Mailing Address - Fax:636-947-9860
Practice Address - Street 1:300 FIRST CAPITOL DRIVE
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301
Practice Address - Country:US
Practice Address - Phone:636-947-5444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOO16294OtherFMH EXCLUSIVE CHOICE
IL06022955OtherBLUE CROSS & BLUE SHIELD
MO117184OtherBLUE CROSS & BLUE SHIELD
MO21317X21317OtherHEALTHCARE USA GROUP NUMB
MO370477200OtherUS DEPARTMENT OF LABOR
MO503988503Medicaid
MO266417OtherFEDERAL BLACK LUNG
MO438386OtherHEALTHLINK GROUP NUMBER
MO4355OtherGROUP HEALTH PLAN