Sovereign Imaging of St Louis

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

2874 Issued in MO

Legal business name

SOVEREIGN IMAGING OF ST LOUIS

Practice address

11652 Studt Ave
Creve Coeur, MO 63141-7025

Phone

(314) 432-2235

NPI assigned

Jul 26, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Robert Matt Trent

Title

Coo

Phone

(405) 842-7768

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508880378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 NW EXPRESSWAY",
            "address_2": "SUITE 1300",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73118",
            "telephone_number": "405-842-7768",
            "fax_number": "405-842-7789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11652 STUDT AVE",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417025",
            "telephone_number": "314-432-2235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOVEREIGN IMAGING OF ST LOUIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TRENT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "MATT",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "405-842-7768",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "MO",
            "license": "2874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Radiology Clinic/Center in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Radiology Clinic/Center in Missouri

• 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.