Provider Demographics
NPI:1063415073
Name:KING'S MEDICAL IMAGING CREVE COEUR, LLC
Entity type:Organization
Organization Name:KING'S MEDICAL IMAGING CREVE COEUR, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:V.
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:COYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-653-3968
Mailing Address - Street 1:1894 GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4058
Mailing Address - Country:US
Mailing Address - Phone:330-653-3968
Mailing Address - Fax:330-656-1660
Practice Address - Street 1:11756 OLIVE STREET RD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-569-3900
Practice Address - Fax:314-569-2734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory