Provider Demographics
NPI:1689956757
Name:MEDSTAR DIAGNOSTIC SERVICES, INC.
Entity Type:Organization
Organization Name:MEDSTAR DIAGNOSTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SURAIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-578-2804
Mailing Address - Street 1:425 SILVER SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 SILVER SPRINGS LN
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4155
Practice Address - Country:US
Practice Address - Phone:972-578-2804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTXUC01Medicare PIN