Organization
IMAGING CENTER OF SALEM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LU BOGOLIN (BILLING MNGR)
(314) 966-6070
Entity
Organization
Contact information
Practice address
1325 W WHITTAKER ST STE D, SALEM, IL 62881-2034
(618) 548-3796
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06130188
BLUE CROSS/BLUE SHIELD
IL
01
—
1235204322
NPI 1ST # GIVEN
IL
01
—
427080
HEALTHLINK
IL
Enumeration date
04/25/2008
Last updated
04/25/2008
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