Provider Demographics
NPI:1609013309
Name:MEDICAL DIAGNOSTIC IMAGING SERVICE
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC IMAGING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HOPE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:504-338-9858
Mailing Address - Street 1:1405 AIRLINE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5901
Mailing Address - Country:US
Mailing Address - Phone:504-352-2307
Mailing Address - Fax:
Practice Address - Street 1:1405 AIRLINE DR
Practice Address - Street 2:SUITE B
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5901
Practice Address - Country:US
Practice Address - Phone:504-352-2307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty