Provider Demographics
NPI:1811228935
Name:MDS DIGITAL X-RAY INC
Entity Type:Organization
Organization Name:MDS DIGITAL X-RAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAMS
Authorized Official - Middle Name:U
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-544-1246
Mailing Address - Street 1:1800 ENVOY CIR
Mailing Address - Street 2:STE 1801
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1854
Mailing Address - Country:US
Mailing Address - Phone:502-491-9141
Mailing Address - Fax:502-491-9176
Practice Address - Street 1:1800 ENVOY CIR
Practice Address - Street 2:STE 1801
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1854
Practice Address - Country:US
Practice Address - Phone:502-491-9141
Practice Address - Fax:502-491-9176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory