Provider Demographics
NPI:1417121690
Name:METROPOLITAN DIAGNOSTICS PA
Entity Type:Organization
Organization Name:METROPOLITAN DIAGNOSTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:TIETJEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-358-8462
Mailing Address - Street 1:12797 W FOREST HILL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4763
Mailing Address - Country:US
Mailing Address - Phone:561-358-8462
Mailing Address - Fax:561-792-0217
Practice Address - Street 1:12797 W FOREST HILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4763
Practice Address - Country:US
Practice Address - Phone:561-358-8462
Practice Address - Fax:561-792-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6776261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service