Provider Demographics
NPI:1881702728
Name:SOUTH COUNTY IMAGING CENTER LLC
Entity type:Organization
Organization Name:SOUTH COUNTY IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAWATMEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-843-8000
Mailing Address - Street 1:12345 W BEND DR
Mailing Address - Street 2:STE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2104
Mailing Address - Country:US
Mailing Address - Phone:314-843-8000
Mailing Address - Fax:314-843-3004
Practice Address - Street 1:12345 W BEND DR
Practice Address - Street 2:STE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2104
Practice Address - Country:US
Practice Address - Phone:314-843-8000
Practice Address - Fax:314-843-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO313190OtherGHP
MO73674OtherHCUSA
1078863OtherUSA MCO
1078863OtherUSA MCO
MOP00415698Medicare PIN