Organization
DES PERES SQUARE IMAGING CENTER LLC
Active
Parent organization
ORTHOPEDIC ASSOCIATES LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ORTHOPEDIC ASSOCIATES LLC
Authorized official
MR. LARRY W POLLEY (EXECUTIVE DIRECTOR)
(314) 569-0612
Entity
Organization
Contact information
Practice address
1050 OLD DES PERES RD, SUITE 75, SAINT LOUIS, MO 63131-1873
(314) 569-2412
(314) 569-1655
Mailing address
1050 OLD DES PERES RD, SUITE 100, SAINT LOUIS, MO 63131-1873
(314) 569-2412
(314) 569-1655
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1601575
UNITED HEALTHCARE
MO
01
—
168483
ANTHEM
MO
01
—
2612904
AETNA
MO
01
—
470001747
MEDICARE RAILROAD PIN
MO
01
—
473861
HEALTHLINK
MO
Enumeration date
08/09/2005
Last updated
03/09/2011
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