Provider Demographics
NPI:1235344516
Name:MEDICAL DIAGNOSTIC SERVICE
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC SERVICE
Other - Org Name:NEVADA PHYSICIAN IMAGING
Other - Org Type:Doing Business As
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 1:2300 CORPORATE CIR
Mailing Address - Street 2:190
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7724
Mailing Address - Country:US
Mailing Address - Phone:702-318-2484
Mailing Address - Fax:702-932-8587
Practice Address - Street 1:700 E WARM SPRINGS RD
Practice Address - Street 2:301
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4305
Practice Address - Country:US
Practice Address - Phone:702-318-2484
Practice Address - Fax:702-932-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty