Organization
EAST RIDGE INVESTMENTS LLC
Active
Organization
EAST RIDGE INVESTMENTS LLC
Active
Other names
St. Joseph Imaging Center
Organization subpart
No
Provider details
NPI number
Authorized official
LASHA DALAKISHVILI (DIRECTOR)
(816) 676-0625
Entity
Organization
Contact information
Practice address
3937 SHERMAN AVE, SAINT JOSEPH, MO 64506-3649
(816) 676-0625
(816) 676-0627
Mailing address
3937 SHERMAN AVE, SAINT JOSEPH, MO 64506-3649
(816) 676-0625
(816) 676-0627
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122536
COVENTRY PIN
MO
05
—
200265470A
—
KS
01
—
31465011
BCBS KC PIN
MO
05
—
710208802
—
MO
01
—
P00173170
MEDICARE RAILROAD
MO
Enumeration date
09/15/2005
Last updated
07/21/2022
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