Healthcare Provider Details

I. General information

NPI: 1962566000
Provider Name (Legal Business Name): MEDICAL DIAGNOSTIC CENTER ASSOCIATES LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18640 E 38TH TER S
INDEPENDENCE MO
64057-2304
US

IV. Provider business mailing address

18640 E 38TH TER S
INDEPENDENCE MO
64057-2304
US

V. Phone/Fax

Practice location:
  • Phone: 816-795-8822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTIN FARRELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 631-513-9851