Organization
RADIOLOGY SPECIALISTS OF ST JOSEPH PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BRUNS (ADMINISTRATOR)
(816) 271-6575
Entity
Organization
Contact information
Practice address
5325 FARAON ST, SAINT JOSEPH, MO 64506-3488
(816) 271-6575
(816) 271-7644
Mailing address
PO BOX 8252, SAINT JOSEPH, MO 64508-8252
(816) 271-6575
(816) 271-7644
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111294
BCBS OF KS FOR KS LOCATIO
KS
05
—
200400950A
—
KS
01
—
32212011
BCBS KC MO
MO
01
—
470766
BCBS OF KS FOR MO LOCATIO
KS
05
—
509395802
—
MO
01
—
CK7871
RR MEDICARE
MO
01
—
DG5299
RR MEDICARE
KS
Enumeration date
06/05/2006
Last updated
07/21/2014
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