Healthcare Provider Details

I. General information

NPI: 1023066438
Provider Name (Legal Business Name): DIAGNOSTIC HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S KIRKWOOD RD SUITE 110
KIRKWOOD MO
63122-7254
US

IV. Provider business mailing address

1001 S KIRKWOOD RD SUITE 110
KIRKWOOD MO
63122-7254
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-9173
  • Fax: 314-821-6157
Mailing address:
  • Phone: 314-821-9173
  • Fax: 314-821-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DONNA L BURCH
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 205-685-5075