Organization
MID-AMERICA IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL M SCHROEDER MD (TREASURER)
(618) 624-0100
Entity
Organization
Contact information
Practice address
1512 N GREEN MOUNT RD, O FALLON, IL 62269
(618) 624-0100
(618) 624-0102
Mailing address
1512 N GREEN MOUNT RD, O FALLON, IL 62269
(618) 624-0100
(618) 624-0102
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
194352
BLUE CROSS BLUE SHIELD
MO
01
—
25607
GROUP HEALTH PLAN
—
01
—
470001974
RR MEDICARE
IL
01
—
8221407
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/02/2006
Last updated
05/08/2017
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