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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