Provider Demographics
NPI:1205159761
Name:ALLEGIANCE MEDICAL X-RAY LLC
Entity type:Organization
Organization Name:ALLEGIANCE MEDICAL X-RAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:B
Authorized Official - Last Name:CAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-772-1441
Mailing Address - Street 1:2331 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139
Mailing Address - Country:US
Mailing Address - Phone:314-772-1441
Mailing Address - Fax:314-772-0600
Practice Address - Street 1:2331 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2908
Practice Address - Country:US
Practice Address - Phone:314-772-1441
Practice Address - Fax:314-772-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier