Provider Demographics
NPI:1811740301
Name:SPECIALT MRI, LLC
Entity type:Organization
Organization Name:SPECIALT MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GE
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)(MR)(ARRT)
Authorized Official - Phone:636-333-1391
Mailing Address - Street 1:2444 FLOWERDALE CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-2745
Mailing Address - Country:US
Mailing Address - Phone:314-783-7054
Mailing Address - Fax:636-333-1343
Practice Address - Street 1:1823 SMIZER STATION RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2781
Practice Address - Country:US
Practice Address - Phone:636-333-1391
Practice Address - Fax:636-333-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier