Provider Demographics
NPI: | 1760716450 |
---|---|
Name: | MDI CONSULTING GROUP, INC. |
Entity Type: | Organization |
Organization Name: | MDI CONSULTING GROUP, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | JAYNE |
Authorized Official - Middle Name: | MAY |
Authorized Official - Last Name: | MONTROSS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 954-862-1432 |
Mailing Address - Street 1: | 12555 ORANGE DR |
Mailing Address - Street 2: | SUITE 230 |
Mailing Address - City: | DAVIE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33330-4304 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-862-1432 |
Mailing Address - Fax: | 954-862-1437 |
Practice Address - Street 1: | 12555 ORANGE DR |
Practice Address - Street 2: | SUITE 230 |
Practice Address - City: | DAVIE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33330-4304 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-862-1432 |
Practice Address - Fax: | 954-862-1437 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-09-28 |
Last Update Date: | 2010-05-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | 261QR0208X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR0208X | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mobile |