Organization
IMAGING CENTER OF SALEM, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LU ANN BOGOLIN (BILLING MNGR)
(314) 966-6070
Entity
Organization
Contact information
Practice address
1325D W WHITTAKER ST, SALEM, IL 62881
(618) 548-3796
(618) 548-3050
Mailing address
PO BOX 31249, SAINT LOUIS, MO 63131-0249
(314) 966-6070
(314) 966-3440
Taxonomy
Speciality
Code
Description
License number
State
207RM1200X
Magnetic Resonance Imaging (MRI) Internal Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06130188
BCBS
IL
01
—
470001830
RR MEDICARE
IL
Enumeration date
11/22/2006
Last updated
01/26/2009
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