1922001080 NPI number — MOBILE DIAGNOSTIC SYSTEMS, INC.

Table of content: (NPI 1922001080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922001080 NPI number — MOBILE DIAGNOSTIC SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE DIAGNOSTIC SYSTEMS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIAGNOSTIC HEALTH SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922001080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5055 KELLER SPRINGS RD
Provider Second Line Business Mailing Address:
STE 500
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-6220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-242-8500
Provider Business Mailing Address Fax Number:
214-242-8600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5055 KELLER SPRINGS RD
Provider Second Line Business Practice Location Address:
STE 500
Provider Business Practice Location Address City Name:
ADDISON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75001-6220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-242-8500
Provider Business Practice Location Address Fax Number:
214-242-8600
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
214-242-8500

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0208X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0084DC . This is a "BCBS OF TEXAS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 088007201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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