Provider Demographics
NPI:1114948445
Name:G MEDICAL DIAGNOSTIC SERVICES, INC.
Entity Type:Organization
Organization Name:G MEDICAL DIAGNOSTIC SERVICES, INC.
Other - Org Name:CARDIOSTAFF CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DISTRIBUTION MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LOHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-212-5508
Mailing Address - Street 1:PO BOX 2153 DEPT 1840
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-1840
Mailing Address - Country:US
Mailing Address - Phone:800-595-2898
Mailing Address - Fax:888-965-7697
Practice Address - Street 1:12708 RIATA VISTA CIR STE A103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-7174
Practice Address - Country:US
Practice Address - Phone:800-595-2898
Practice Address - Fax:512-212-9490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0488DCOtherBCBS TX
TX164090601Medicaid
NE10025090400Medicaid
NE10025090400Medicaid
TXFTC006Medicare PIN