Healthcare Provider Details

I. General information

NPI: 1215397153
Provider Name (Legal Business Name): MISSOURI DIAGNOSTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 COPPER RD
HOLTS SUMMIT MO
65043-2033
US

IV. Provider business mailing address

1517 COPPER RD
HOLTS SUMMIT MO
65043-2033
US

V. Phone/Fax

Practice location:
  • Phone: 660-207-0031
  • Fax: 877-673-5233
Mailing address:
  • Phone: 660-207-0031
  • Fax: 877-673-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ALEEM ABBASI
Title or Position: SECRETARY/ MEMBER
Credential:
Phone: 660-207-0031