Provider Demographics
NPI:1982073656
Name:CHESTERFIELD IMAGING, LLC
Entity Type:Organization
Organization Name:CHESTERFIELD IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHRANCK
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:636-449-3990
Mailing Address - Street 1:14825 N OUTER 40 RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2152
Mailing Address - Country:US
Mailing Address - Phone:636-449-3990
Mailing Address - Fax:636-449-3997
Practice Address - Street 1:14825 N OUTER 40 RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2152
Practice Address - Country:US
Practice Address - Phone:636-449-3990
Practice Address - Fax:636-449-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001461910261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology