Provider Demographics
NPI:1962733139
Name:LODIN MEDICAL IMAGING, LLC
Entity type:Organization
Organization Name:LODIN MEDICAL IMAGING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:MASODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-781-9711
Mailing Address - Street 1:3915 WATSON RD
Mailing Address - Street 2:SUITE LL2
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-1251
Mailing Address - Country:US
Mailing Address - Phone:314-781-9711
Mailing Address - Fax:314-781-9468
Practice Address - Street 1:3915 WATSON RD
Practice Address - Street 2:SUITE LL2
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1251
Practice Address - Country:US
Practice Address - Phone:314-781-9711
Practice Address - Fax:314-781-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MammographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2358Medicare PIN