Provider Demographics
NPI:1457305856
Name:MEDICAL DIAGNOSTIC SERVICES, INC.
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC SERVICES, INC.
Other - Org Name:NEVADA PHYSICIANS IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTOPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-940-2629
Mailing Address - Street 1:6301 MOUNTAIN VISTA ST.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2631
Mailing Address - Country:US
Mailing Address - Phone:702-940-2650
Mailing Address - Fax:702-933-4289
Practice Address - Street 1:6301 MOUNTAIN VISTA ST.
Practice Address - Street 2:SUITE 101
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2631
Practice Address - Country:US
Practice Address - Phone:702-777-1200
Practice Address - Fax:702-933-4289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1457305856Medicaid
NVV39013Medicare PIN