Organization
CARDIAC DIAGNOSTIC CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAT LOPEZ (OFFICE MANAGER)
(314) 543-5270
Entity
Organization
Contact information
Practice address
10004 KENNERLY RD, SUITE 281B, SAINT LOUIS, MO 63128-2141
(314) 543-5270
(314) 543-5289
Mailing address
10004 KENNERLY RD, SUITE 281B, SAINT LOUIS, MO 63128-2141
(314) 543-5270
(314) 543-5289
Taxonomy
Speciality
Code
Description
License number
State
207UN0902X
Nuclear Imaging & Therapy Physician
Primary
4560
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
157621
BLUE CROSS/ BLUE SHIELD
MO
01
—
27454
BLUE CHOICE
MO
01
—
511284
HEALTHLINK
MO
01
—
8285720
CIGNA
MO
01
—
A11496
MERCY
MO
01
—
CJ7575
RAILROAD MEDICARE
MO
Enumeration date
12/13/2005
Last updated
08/13/2009
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