Provider Demographics
NPI:1912239856
Name:ACCATUR DIAGNOSTICS 1, LLC
Entity Type:Organization
Organization Name:ACCATUR DIAGNOSTICS 1, LLC
Other - Org Name:MEDICAL DIAGNOSTIC CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PALM-LEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-720-4664
Mailing Address - Street 1:PO BOX 61240
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91116-7240
Mailing Address - Country:US
Mailing Address - Phone:310-720-4664
Mailing Address - Fax:
Practice Address - Street 1:1000 LAGUNA RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2320
Practice Address - Country:US
Practice Address - Phone:310-720-4664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies