Provider Demographics
NPI:1457389694
Name:MEDICAL DIAGNOSTIC SERVICES, LTD.
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:REBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-489-0263
Mailing Address - Street 1:90 CHAMBER PLZ
Mailing Address - Street 2:
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-1620
Mailing Address - Country:US
Mailing Address - Phone:724-489-0263
Mailing Address - Fax:724-489-0267
Practice Address - Street 1:410 CRANBERRY ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1067
Practice Address - Country:US
Practice Address - Phone:814-480-8040
Practice Address - Fax:814-480-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002121Medicare ID - Type Unspecified