Provider Demographics
NPI:1346542388
Name:MIDWEST DIAGNOSTIC SERVICES LLC
Entity Type:Organization
Organization Name:MIDWEST DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAGRAMANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-875-9101
Mailing Address - Street 1:4144 LINDELL BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2927
Mailing Address - Country:US
Mailing Address - Phone:314-875-9101
Mailing Address - Fax:314-875-9110
Practice Address - Street 1:4144 LINDELL BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2927
Practice Address - Country:US
Practice Address - Phone:314-875-9101
Practice Address - Fax:314-875-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory