MEDICARE: HI TECH DIAGNOSTICS 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	261QR0200X	Radiology Clinic/Center	LC1185408	MO

General Provider Information

NPI Number	:	1558617035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HI TECH DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	16502 BARRISTER LN
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-4602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16502 BARRISTER LN
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-4602
Country	:	US
Telephone Number	:	636-222-3070
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SYED TANVEER HAIDER
Credential	:
Telephone Number	:	636-222-3070

Provider Enumeration Date	:	08/02/2012
Last Update Date	:	08/02/2012

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