Provider Demographics
NPI:1689883043
Name:MED-SCAN, INC
Entity Type:Organization
Organization Name:MED-SCAN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-827-7200
Mailing Address - Street 1:26222 TELEGRAPH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5318
Mailing Address - Country:US
Mailing Address - Phone:248-827-7200
Mailing Address - Fax:248-827-2641
Practice Address - Street 1:G3259 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3615
Practice Address - Country:US
Practice Address - Phone:810-732-1560
Practice Address - Fax:810-732-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B56290OtherBCBS
MI0B56290Medicare PIN