Provider Demographics
NPI:1669419784
Name:MEDICAL DIAGNOSTIC SERVICE INC
Entity type:Organization
Organization Name:MEDICAL DIAGNOSTIC SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-237-0848
Mailing Address - Street 1:P.O. BOX 63
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27894
Mailing Address - Country:US
Mailing Address - Phone:252-237-0848
Mailing Address - Fax:252-237-0848
Practice Address - Street 1:705 N. WARD BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27894
Practice Address - Country:US
Practice Address - Phone:252-237-0848
Practice Address - Fax:252-237-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty