Provider Demographics
NPI:1497761795
Name:MEDICAL DIAGNOSTIC SERVICES LTD
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-325-5860
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499
Mailing Address - Country:US
Mailing Address - Phone:505-326-5860
Mailing Address - Fax:505-325-0689
Practice Address - Street 1:657A W MAPLE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-326-5860
Practice Address - Fax:505-325-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46094Medicaid
NM46094Medicaid
2258575Medicare ID - Type Unspecified