# MIDWEST DIAGNOSTIC IMAGING CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417139023
- **Authorized official:** MR. THOMAS BOB ROSS JR. (PRESIDENT CEO)
- **Authorized official phone:** (866) 504-2674

## Contact information

- **Practice address:** 4120 LINDELL BLVD, SAINT LOUIS, MO 63108-2914
- **Practice address phone:** (866) 504-2674
- **Mailing address:** 3920 LINDELL BLVD, SUITE 210, SAINT LOUIS, MO 63108-3254
- **Mailing address phone:** (866) 504-2674

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | — | MO | Yes |
| 261QR0206X | Mammography Clinic/Center | — | MO | — |

## Other

- **Enumeration date:** 12/05/2007
- **Last updated:** 12/05/2007