Provider Demographics
NPI:1417414426
Name:PALMETTO DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:PALMETTO DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:AUDIE
Authorized Official - Last Name:MCGRAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-381-6152
Mailing Address - Street 1:222 CREEK STONE DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-0709
Mailing Address - Country:US
Mailing Address - Phone:318-381-6152
Mailing Address - Fax:
Practice Address - Street 1:222 CREEK STONE DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-0709
Practice Address - Country:US
Practice Address - Phone:318-381-6152
Practice Address - Fax:855-373-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier