| Organization Name: | ST. LOUIS BREAST CENTER LLC |
| NPI Number: | 1043512999 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD MUCKERMAN (PRESIDENT) |
| Mailing Address: | 884 Woods Mill Rd Suite 203 Ballwin |
| State: | MO US |
| Postal Code: | 630113657 |
| Phone Number: | 6367798008 |
| Fax Number: | |
| NPI Enumeration Date: | 11/29/2010 |
| NPI Last Update Date: | 11/29/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0206X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology, Mammography |
| Taxonomy Definition: | |