Provider Demographics
NPI:1053089524
Name:MEDI-WHEELS DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:MEDI-WHEELS DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CIMINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-944-8693
Mailing Address - Street 1:5005 LBJ FWY STE 840
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6103
Mailing Address - Country:US
Mailing Address - Phone:918-808-2470
Mailing Address - Fax:
Practice Address - Street 1:5005 LBJ FWY STE 840
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-6103
Practice Address - Country:US
Practice Address - Phone:512-944-8693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDI-WHEELS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-31
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory