Provider Demographics
NPI:1821180639
Name:UNITED DIAGNOSTIC SERVICES INC
Entity Type:Organization
Organization Name:UNITED DIAGNOSTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-721-5803
Mailing Address - Street 1:9495 PAGE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1521
Mailing Address - Country:US
Mailing Address - Phone:314-721-5803
Mailing Address - Fax:314-218-2221
Practice Address - Street 1:9495 PAGE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1521
Practice Address - Country:US
Practice Address - Phone:314-721-5803
Practice Address - Fax:314-218-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000047071Medicare ID - Type Unspecified