MEDICARE: PDI HEALTH OK LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1255956769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PDI HEALTH OK LLC

Provider Business Mailing Address
First Line	:	12 SPENCER ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-1891
Country	:	US
Telephone Number	:	800-749-9729
Fax Number	:

Provider Business Practice Location Address
First Line	:	8211 E REGAL PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-7167
Country	:	US
Telephone Number	:	800-749-9729
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MENACHEM TAUBER
Credential	:
Telephone Number	:	800-749-9729

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	06/10/2020

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Directions to “PDI HEALTH OK LLC ” Practice Location

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