Provider Demographics
NPI:1851460646
Name:MEDEVEOP,LLC
Entity Type:Organization
Organization Name:MEDEVEOP,LLC
Other - Org Name:DESERT STAND-UP MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLODKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-887-8788
Mailing Address - Street 1:PO BOX 90876
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92427-1876
Mailing Address - Country:US
Mailing Address - Phone:909-887-8788
Mailing Address - Fax:909-887-6345
Practice Address - Street 1:79440 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 118
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7241
Practice Address - Country:US
Practice Address - Phone:760-564-5011
Practice Address - Fax:760-564-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A332571Medicaid
CA00A332571Medicaid