1740239680 NPI number — MEDICAL DIAGNOSTIC SERVICES, INC.

Table of content: (NPI 1740239680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740239680 NPI number — MEDICAL DIAGNOSTIC SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL DIAGNOSTIC SERVICES, 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:
NEVADA PHYSICIANS IMAGING
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:
1740239680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6301 MOUNTAIN VISTA ST.
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89014-2631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-940-2650
Provider Business Mailing Address Fax Number:
702-933-4289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4275 BURNHAM AVE
Provider Second Line Business Practice Location Address:
#127B
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89119-6541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-448-8457
Provider Business Practice Location Address Fax Number:
702-448-8486
Provider Enumeration Date:
05/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHRISTOPHERSON
Authorized Official First Name:
GREG
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS DIRECTOR
Authorized Official Telephone Number:
702-940-2629

Provider Taxonomy Codes

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

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

  • Identifier: 1740239680 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".