Provider Demographics
NPI:1962432492
Name:SIGNATURE HEALTH SERVICES
Entity type:Organization
Organization Name:SIGNATURE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-849-0311
Mailing Address - Street 1:12639 OLD TESSON ROAD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:314-849-4423
Practice Address - Street 1:12639 OLD TESSON ROAD
Practice Address - Street 2:SUITE 125
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2786
Practice Address - Country:US
Practice Address - Phone:314-849-0311
Practice Address - Fax:314-849-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2024-12-02
Deactivation Date:2024-04-12
Deactivation Code:
Reactivation Date:2024-06-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO711357707Medicaid
MO1601036OtherUNITED HEALTHCARE
MO194369OtherBLUE CROSS BLUE SHIELD
MO81493OtherGROUP HEALTHPLAN
MO0725114OtherCIGNA
MO620955OtherHEALTHLINK
MO000012295Medicare PIN