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BOONSLICK MEDICAL GROUP INC NPI 1972666162


NPI Information

NPI: 1972666162
Provider Name: BOONSLICK MEDICAL GROUP INC
Classification: Radiology - 2085R0202X
Entity Type: Organization

Specialization: Diagnostic Radiology

CLIA Number: 26D0440988

Address:
1301 BOONES LICK RD
SAINT CHARLES, MO
ZIP 63301
Phone: (636) 916-8228
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BOONSLICK MEDICAL GROUP INC is a diagnostic radiology radiology in Saint Charles, MO. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. BOONSLICK MEDICAL GROUP INC NPI is 1972666162. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1301 BOONES LICK RD
SAINT CHARLES, MO
ZIP 63301-463
Phone: (636) 916-8228
Fax: (636) 946-5774

The provider's authorized official is Robert B Cusworth .
The authorized official title is President, Boonslick Med. Group Inc and has the following contact phone number (636) 947-3392.

The CLIA number assigned to this NPI record is 26D0440988 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 12/18/2006 and was last updated on 7/21/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12085R0202XRadiologyDiagnostic RadiologyMISSOURIYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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