Organization
SOUTHTOWNE IMAGING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HENRY BOOTS (OWNER/MANAGER)
(573) 315-9109
Entity
Organization
Contact information
Practice address
20 SOUTHTOWNE DR, POTOSI, MO 63664-5729
(573) 436-6736
(573) 436-7321
Mailing address
20 SOUTHTOWNE DR, POTOSI, MO 63664-5729
(573) 436-6736
(573) 436-7321
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
269801
GHP NUMBER
MO
01
—
59787
HEALTHCARE USA NUMBER
MO
05
—
710002502
—
MO
01
—
P00277531
RAILROAD MEDICARE NUMBER
MO
Enumeration date
11/21/2006
Last updated
02/17/2015
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