Provider Demographics
NPI:1275278350
Name:PDI HEALTH MO LLC
Entity Type:Organization
Organization Name:PDI HEALTH MO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MENACHEM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-924-7211
Mailing Address - Street 1:12 SPENCER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1892
Mailing Address - Country:US
Mailing Address - Phone:718-388-3300
Mailing Address - Fax:
Practice Address - Street 1:111 W PORT PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3011
Practice Address - Country:US
Practice Address - Phone:800-749-9729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile