Healthcare Provider Details

I. General information

NPI: 1962733139
Provider Name (Legal Business Name): LODIN MEDICAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 WATSON RD SUITE LL2
SAINT LOUIS MO
63109-1251
US

IV. Provider business mailing address

3915 WATSON RD SUITE LL2
SAINT LOUIS MO
63109-1251
US

V. Phone/Fax

Practice location:
  • Phone: 314-781-9711
  • Fax: 314-781-9468
Mailing address:
  • Phone: 314-781-9711
  • Fax: 314-781-9468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MATT MASODY
Title or Position: OWNER
Credential:
Phone: 314-781-9711