Provider Demographics
NPI:1679013643
Name:CITY DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:CITY DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-853-0469
Mailing Address - Street 1:1408 N KINGSHIGHWAY BLVD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-1400
Mailing Address - Country:US
Mailing Address - Phone:314-696-2489
Mailing Address - Fax:314-667-3212
Practice Address - Street 1:1408 N KINGSHIGHWAY BLVD
Practice Address - Street 2:SUITE 224
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-1400
Practice Address - Country:US
Practice Address - Phone:314-696-2489
Practice Address - Fax:314-667-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001491707305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization