Provider Demographics
NPI:1891047536
Name:MEDICAL DIAGNOSTIC IMAGING GROUP LTD
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC IMAGING GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-246-2584
Mailing Address - Street 1:PO BOX 97641
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-7641
Mailing Address - Country:US
Mailing Address - Phone:855-613-5393
Mailing Address - Fax:
Practice Address - Street 1:800 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-1954
Practice Address - Country:US
Practice Address - Phone:575-894-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM270747Medicare PIN