MEDICARE: UNITED DIAGNOSTIC SERVICES INC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1821180639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED DIAGNOSTIC SERVICES INC

Provider Business Mailing Address
First Line	:	9495 PAGE AVE
Second Line	:	SUITE 103
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-1521
Country	:	US
Telephone Number	:	314-721-5803
Fax Number	:	314-218-2221

Provider Business Practice Location Address
First Line	:	9495 PAGE AVE
Second Line	:	SUITE 103
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-1521
Country	:	US
Telephone Number	:	314-721-5803
Fax Number	:	314-218-2221

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. ROGER M. BERENT
Credential	:
Telephone Number	:	314-721-5803

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	02/26/2009

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Directions to “UNITED DIAGNOSTIC SERVICES INC ” Practice Location

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