Provider Demographics
NPI:1689618951
Name:DIAGNOSTIC MEDICAL SERVICES INC.
Entity Type:Organization
Organization Name:DIAGNOSTIC MEDICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:III
Authorized Official - Credentials:RDMS
Authorized Official - Phone:302-292-2700
Mailing Address - Street 1:25 S OLD BALTIMORE PIKE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1540
Mailing Address - Country:US
Mailing Address - Phone:302-292-2700
Mailing Address - Fax:302-292-2702
Practice Address - Street 1:25 S OLD BALTIMORE PIKE
Practice Address - Street 2:SUITE 104
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1540
Practice Address - Country:US
Practice Address - Phone:302-292-2700
Practice Address - Fax:302-292-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE19890259312471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000197322OtherHIGHMARK BLUE SHIELD
DE0000563702Medicaid
PA0091836000OtherPERSONAL CHOICE BLUE SHIE
=========OtherTRICARE NORTH
DE=========OtherOPTIMUM CHOICE
PA0091836000OtherPERSONAL CHOICE BLUE SHIE
DE0000563702Medicaid
DE=========OtherBUECROSS BLUSSHIELD OF DE
DE0000563702Medicaid
PA000197322OtherHIGHMARK BLUE SHIELD