Organization
MIA OF ST CHARLES COUNTY LLC
Active
Other names
Clinical PET of St Charles County
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN MICHAEL MCRAE (MANAGING MEMBER)
(618) 659-1167
Entity
Organization
Contact information
Practice address
1475 KISKER RD, STE 145, SAINT CHARLES, MO 63304-8781
(636) 922-5151
(636) 922-5454
Mailing address
PO BOX 868, EDWARDSVILLE, IL 62025-0868
(618) 659-1167
(618) 659-1197
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
09/19/2005
Last updated
08/22/2020
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