NPIMap

Organization Active NPI

St. Lukes Center for Diagnostic Imaging LLC

  • Diagnostic Radiology Physician
  • Creve Coeur, MO
National Provider Identifier
1497791321
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
ST. LUKES CENTER FOR DIAGNOSTIC IMAGING LLC
Practice address
11605 Studt Avenue
Ste 107
Creve Coeur, MO 63141
Phone
(314) 872-7460
Fax
(314) 872-7495
NPI assigned
Jun 20, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donald D Jacobsen
Title
Officer on the Board Secretary
Phone
(952) 543-6500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

11605 Studt Avenue
Ste 107
Creve Coeur, MO 63141

Mailing address

PO Box 790120
St. Louis, MO 63179-0120
Phone (952) 542-8553

National Provider Directory

National Provider Directory
Tax ID family
St Lukes Center for Diagnostic Imaging LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497791321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790120",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "631790120",
            "telephone_number": "952-542-8553",
            "fax_number": "952-513-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11605 STUDT AVENUE",
            "address_2": "STE 107",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "63141",
            "telephone_number": "314-872-7460",
            "fax_number": "314-872-7495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LUKES CENTER FOR DIAGNOSTIC IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACOBSEN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OFFICER ON THE BOARD SECRETARY",
        "authorized_official_telephone_number": "952-543-6500"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Creve Coeur, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.