Mia of St Charles County LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MIA OF ST CHARLES COUNTY LLC

Doing business as

Clinical PET of St Charles County

Practice address

1475 Kisker Rd
Ste 145
Saint Charles, MO 63304-8781

Phone

(636) 922-5151

Fax

(636) 922-5454

NPI assigned

Sep 19, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Steven Michael McRae

Title

Managing Member

Phone

(618) 659-1167

Specialties & licenses 1

Addresses

Other names 1

• Clinical PET of St Charles County Doing business as

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922093632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 868",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620250868",
            "telephone_number": "618-659-1167",
            "fax_number": "618-659-1197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 KISKER RD",
            "address_2": "STE 145",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633048781",
            "telephone_number": "636-922-5151",
            "fax_number": "636-922-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIA OF ST CHARLES COUNTY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCRAE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "618-659-1167",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinical PET of St Charles County",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christine Clare Meyer, RNFA
• Douglas L Meyer
• Elizabeth Stansbrough Meyer, DDS
• Wendy Lynn Meyr-Cherry, M.D.
• Mgmllc
• Michael Kimble, DMD, P.C.
• Michael L. Yang, D.D.S., LLC
• Michelle L Dunajcik, LLC
• Rachel Micu, MA, LPC
• Middle Path Wellness Collective

• Clinic/Center in Saint Charles, MO
• Providers in Saint Charles, MO by specialty
• 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.