Provider Demographics
NPI:1922349497
Name:PROFESSIONAL DIAGNOSTICS READING
Entity Type:Organization
Organization Name:PROFESSIONAL DIAGNOSTICS READING
Other - Org Name:PDR IMAGING TRAILER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTHERSIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-616-9095
Mailing Address - Street 1:4100 N POWERLINE RD
Mailing Address - Street 2:STE G2
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3083
Mailing Address - Country:US
Mailing Address - Phone:954-828-5999
Mailing Address - Fax:954-858-5354
Practice Address - Street 1:4100 N POWERLINE RD
Practice Address - Street 2:STE G2
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33073-3083
Practice Address - Country:US
Practice Address - Phone:954-828-5999
Practice Address - Fax:954-858-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory