East Ridge Investments LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

EAST RIDGE INVESTMENTS LLC

Doing business as

St. Joseph Imaging Center

Practice address

3937 Sherman Ave
Saint Joseph, MO 64506-3649

Phone

(816) 676-0625

Fax

(816) 676-0627

NPI assigned

Sep 15, 2005

Organization subpart

No

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

Authorized official

Name

Lasha Dalakishvili

Title

Director

Phone

(816) 676-0625

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• St. Joseph Imaging Center Doing business as

Locations

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1902891955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3937 SHERMAN AVE",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645063649",
            "telephone_number": "816-676-0625",
            "fax_number": "816-676-0627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3937 SHERMAN AVE",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645063649",
            "telephone_number": "816-676-0625",
            "fax_number": "816-676-0627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST RIDGE INVESTMENTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DALAKISHVILI",
        "authorized_official_first_name": "LASHA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "816-676-0625"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY PIN",
            "identifier": "122536",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "710208802",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200265470A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00173170",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS KC PIN",
            "identifier": "31465011",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Joseph Imaging Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shelby L Duran, MSN, RN, AGACNP-BC
• Dva Renal Healthcare Inc
• Barbara Petranella Dyer, MD
• Bradley R Dyer, M.D.
• East Ridge Investments LLC
• Eastridge Medical Laboratory Inc
• Brent James Eaton, DO
• Kristy Eaton, LPC
• Michael Ray Eaton, PMHNP-BC
• Logan Eck, ATC, LAT

• Diagnostic Radiology Physician in Saint Joseph, MO
• Providers in Saint Joseph, MO by specialty
• Diagnostic Radiology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.