Organization
OPENSIDED MRI OF ST LOUIS, LLC
Active
Other names
Greater Missouri Imaging, Greater Missouri OpenSided MRI & CT
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER S MOON (MANAGER)
(314) 514-0167
Entity
Organization
Contact information
Practice address
12101 OLIVE BLVD, CREVE COEUR, MO 63141-6628
(314) 514-0167
(314) 514-8773
Mailing address
12101 OLIVE BLVD, CREVE COEUR, MO 63141-6628
(314) 514-0167
(314) 514-8773
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000488078
BCBS PIN
MO
05
—
503823304
—
MO
Enumeration date
06/03/2006
Last updated
01/14/2025
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