Provider Demographics
NPI:1043358229
Name:MEDICAL CENTER DIAGNOSTICS LLC
Entity type:Organization
Organization Name:MEDICAL CENTER DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NORTON
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-809-0000
Mailing Address - Street 1:67250 INDUSTRY LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8716
Mailing Address - Country:US
Mailing Address - Phone:985-809-0000
Mailing Address - Fax:985-898-3827
Practice Address - Street 1:67250 INDUSTRY LN
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8716
Practice Address - Country:US
Practice Address - Phone:985-809-0000
Practice Address - Fax:985-898-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG1502OtherBLUE CROSS P.E.T.