Provider Demographics
NPI:1225162373
Name:MDIAGNOSTIX
Entity Type:Organization
Organization Name:MDIAGNOSTIX
Other - Org Name:QUALITY PORTABLE X-RAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:L
Authorized Official - Last Name:AUGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-495-9204
Mailing Address - Street 1:4486 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4513
Mailing Address - Country:US
Mailing Address - Phone:954-741-8583
Mailing Address - Fax:
Practice Address - Street 1:4486 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-4513
Practice Address - Country:US
Practice Address - Phone:954-741-8583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLW9910Medicare ID - Type UnspecifiedPORTABLE X-RAY