Organization
MIDWEST IMAGING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER M SKINNER (OFFICE MANAGER)
(573) 756-7779
Entity
Organization
Contact information
Practice address
604 MAPLE VALLEY DR, FARMINGTON, MO 63640-1976
(573) 760-1674
(573) 760-0228
Mailing address
604 MAPLE VALLEY DR, FARMINGTON, MO 63640-1976
(573) 760-1674
(573) 760-0228
Taxonomy
Speciality
Code
Description
License number
State
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
717263305
—
MO
Enumeration date
02/03/2006
Last updated
11/02/2011
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