1609868488 NPI number — MEDICAL DIAGNOSIS PORTABLE X-RAY & EKG SERVICES INC. MDX

Table of content: (NPI 1609868488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609868488 NPI number — MEDICAL DIAGNOSIS PORTABLE X-RAY & EKG SERVICES INC. MDX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL DIAGNOSIS PORTABLE X-RAY & EKG SERVICES INC. MDX
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:
MDX MEDICAL DIAGNOSIS PORTABLE X-RAY
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:
1609868488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4139 MAMMOTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91423-4323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-281-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5627 SEPULVEDA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91411-2920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-281-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BENJAMIN
Authorized Official First Name:
BIALIK
Authorized Official Middle Name:
VAHDAT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-281-4000

Provider Taxonomy Codes

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

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

  • Identifier: TG092 . This is a "MEDICARE(ULTRASOUND)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 630000095 . This is a "PALMETTO GBARAILROAD MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: XRO59933F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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