Provider Demographics
NPI:1457399172
Name:MEDEXPRESS DIAGNOSTIC INC.
Entity Type:Organization
Organization Name:MEDEXPRESS DIAGNOSTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:SHVEDOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-553-3559
Mailing Address - Street 1:5170 SEPULVEDA BLVD
Mailing Address - Street 2:#280
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1171
Mailing Address - Country:US
Mailing Address - Phone:818-986-3559
Mailing Address - Fax:818-986-3550
Practice Address - Street 1:5170 SEPULVEDA BLVD
Practice Address - Street 2:280
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1171
Practice Address - Country:US
Practice Address - Phone:818-986-3559
Practice Address - Fax:818-986-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATGO64Medicare ID - Type UnspecifiedIDTF