Provider Demographics
NPI:1518419068
Name:PMDTC, LLC
Entity Type:Organization
Organization Name:PMDTC, LLC
Other - Org Name:TOWN AND COUNTRY DIAGNOSTICS II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:1600 W BROADWAY RD STE 155
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1138
Mailing Address - Country:US
Mailing Address - Phone:949-487-9500
Mailing Address - Fax:
Practice Address - Street 1:30 HUGHES
Practice Address - Street 2:STE 208
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1916
Practice Address - Country:US
Practice Address - Phone:619-268-1632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW0032OtherMEDICARE PART B PROVIDER NUMBER