Provider Demographics
NPI:1770725962
Name:IMAGING ADVANTAGE LLC
Entity type:Organization
Organization Name:IMAGING ADVANTAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BASSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHABALLOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-721-0200
Mailing Address - Street 1:6245 LEMAY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-2805
Mailing Address - Country:US
Mailing Address - Phone:800-354-1088
Mailing Address - Fax:314-845-5668
Practice Address - Street 1:425 W FIFTH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2405
Practice Address - Country:US
Practice Address - Phone:866-708-6580
Practice Address - Fax:314-845-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty