Provider Demographics
NPI:1366609919
Name:NORTH COUNTY DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY, INC
Entity type:Organization
Organization Name:NORTH COUNTY DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAADOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KADIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-838-9876
Mailing Address - Street 1:2909 NETHERTON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-4677
Mailing Address - Country:US
Mailing Address - Phone:314-838-9876
Mailing Address - Fax:
Practice Address - Street 1:2909 NETHERTON DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-4677
Practice Address - Country:US
Practice Address - Phone:314-838-9876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506904101Medicaid