Organization
ST LUKES CENTER FOR DIAGNOSTIC IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD D JACOBSEN (OFFICER ON THE BOARD SECRETARY)
(952) 543-6500
Entity
Organization
Contact information
Practice address
5551 WINGHAVEN BOULEVARD, SUITE 60, OFALLON, MO 63368-3618
(636) 625-4434
(636) 625-4432
Mailing address
PO BOX 790120, ST LOUIS, MO 63179-0120
(952) 542-8553
(952) 513-6880
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
06/21/2006
Last updated
07/21/2008
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