Provider Demographics
NPI:1700814381
Name:MID-WEST DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:MID-WEST DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAKE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SEYSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-550-9999
Mailing Address - Street 1:PO BOX 4064
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91222-0064
Mailing Address - Country:US
Mailing Address - Phone:818-550-9999
Mailing Address - Fax:818-550-9996
Practice Address - Street 1:401 N BRAND BLVD STE 750
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4450
Practice Address - Country:US
Practice Address - Phone:818-550-9999
Practice Address - Fax:818-550-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile