Provider Demographics
NPI:1245696731
Name:BTX KOI INC
Entity type:Organization
Organization Name:BTX KOI INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:BISHOP
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:314-440-1770
Mailing Address - Street 1:1065 EXECUTIVE PARKWAY DR STE 220
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6367
Mailing Address - Country:US
Mailing Address - Phone:314-440-1770
Mailing Address - Fax:
Practice Address - Street 1:6802 MENZ LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45233-4311
Practice Address - Country:US
Practice Address - Phone:513-741-1600
Practice Address - Fax:513-741-0960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BTX IOWA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-13
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
293D00000X
KYK200140335V00000X
OHH444850335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH444850OtherMEDICARE PTAN
MIMI19984OtherMEDICARE PTAN
ININ3852OtherMEDICARE PTAN
KYK200140OtherMEDICARE PTAN