Provider Demographics
NPI:1033544630
Name:ATLANTIC DIAGNOSTIC SERVICES, LLC
Entity Type:Organization
Organization Name:ATLANTIC DIAGNOSTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-469-3000
Mailing Address - Street 1:1785 NONCONNAH BOULEVARD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38132-2140
Mailing Address - Country:US
Mailing Address - Phone:662-449-8200
Mailing Address - Fax:888-891-3929
Practice Address - Street 1:165 W SOUTH STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2266
Practice Address - Country:US
Practice Address - Phone:855-717-6838
Practice Address - Fax:888-371-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory