Provider Demographics
NPI:1487831236
Name:MEDICAL DIAGNOSTIC CONSULTANTS PA
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOLENDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-861-4114
Mailing Address - Street 1:PO BOX 980308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-0308
Mailing Address - Country:US
Mailing Address - Phone:713-861-4114
Mailing Address - Fax:281-605-1966
Practice Address - Street 1:5900 MEMORIAL DR STE 215
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-8030
Practice Address - Country:US
Practice Address - Phone:713-861-4114
Practice Address - Fax:281-605-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization