Organization
RADIOLOGIC IMAGING CONSULTANTS, LLP
Active
Organization
RADIOLOGIC IMAGING CONSULTANTS, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN ROOT M.D. (PARTNER)
(636) 947-4480
Entity
Organization
Contact information
Practice address
300 FIRST CAPITOL DRIVE, ST CHARLES, MO 63301
(636) 947-5444
Mailing address
220 COMPASS POINT DR, ST CHARLES, MO 63301
(636) 947-4480
(636) 947-9860
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06022955
BLUE CROSS & BLUE SHIELD
IL
01
—
117184
BLUE CROSS & BLUE SHIELD
MO
01
—
21317X21317
HEALTHCARE USA GROUP NUMB
MO
01
—
266417
FEDERAL BLACK LUNG
MO
01
—
370477200
US DEPARTMENT OF LABOR
MO
01
—
4355
GROUP HEALTH PLAN
MO
01
—
438386
HEALTHLINK GROUP NUMBER
MO
05
—
503988503
—
MO
01
—
O16294
FMH EXCLUSIVE CHOICE
MO
Enumeration date
10/04/2006
Last updated
02/16/2022
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