Organization
ERNST RADIOLOGY CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT GRESICK MD (PRESIDENT)
(314) 344-6350
Entity
Organization
Contact information
Practice address
12303 DEPAUL DR, DEPAUL HEALTH CENTER, BRIDGETON, MO 63044
(314) 344-6350
Mailing address
12255 DEPAUL DR, STE 737, BRIDGETON, MO 63044-2530
(314) 770-9393
(314) 770-9997
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
710545609
—
MO
Enumeration date
07/07/2006
Last updated
03/22/2022
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