Provider Demographics
NPI:1598073330
Name:MDSI, INC.
Entity Type:Organization
Organization Name:MDSI, INC.
Other - Org Name:SENIOR HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:REEVES
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-512-1245
Mailing Address - Street 1:2529 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-5062
Mailing Address - Country:US
Mailing Address - Phone:423-512-1245
Mailing Address - Fax:423-297-1014
Practice Address - Street 1:2529 BEECHWOOD DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-5062
Practice Address - Country:US
Practice Address - Phone:423-512-1245
Practice Address - Fax:423-297-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty