Organization
MAPLE CREST OPEN MRI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT LUTHER ROSSOW DO (OWNER/PHYSICIAN)
(417) 339-9800
Entity
Organization
Contact information
Practice address
840 W KANSAS AVENUE, STE A, LIBERTY, MO 64068-2033
(816) 587-1818
(816) 505-5004
Mailing address
840 W KANSAS ST, SUITE A, LIBERTY, MO 64068-2033
(816) 781-9797
(816) 781-9793
Taxonomy
Speciality
Code
Description
License number
State
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34425017
BLUE CROSS BLUE SHIELD
MO
01
—
P00152744
RAILROAD MEDICARE
MO
Enumeration date
11/02/2006
Last updated
08/27/2014
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