Provider Demographics
NPI:1053341032
Name:MEDICAL DIAGNOSTIC SERVICES
Entity type:Organization
Organization Name:MEDICAL DIAGNOSTIC SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MALISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:THATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-932-8547
Mailing Address - Street 1:700 E WARM SPRINGS RD
Mailing Address - Street 2:301
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4305
Mailing Address - Country:US
Mailing Address - Phone:702-932-8547
Mailing Address - Fax:
Practice Address - Street 1:600 WHITNEY RANCH DR
Practice Address - Street 2:B9
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2611
Practice Address - Country:US
Practice Address - Phone:702-933-1315
Practice Address - Fax:702-933-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology