Healthcare Provider Details

I. General information

NPI: 1134522410
Provider Name (Legal Business Name): TK DIAGNOSTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 RAYMALEY RD
HARRISON CITY PA
15636
US

IV. Provider business mailing address

1024 W 13TH STREET
LAKELAND FL
33805
US

V. Phone/Fax

Practice location:
  • Phone: 412-607-2985
  • Fax:
Mailing address:
  • Phone: 412-607-2985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name: MRS. KARRIE WOODCOCK
Title or Position: OWNER
Credential:
Phone: 724-744-0551