Healthcare Provider Details

I. General information

NPI: 1104982719
Provider Name (Legal Business Name): APEX DIAGNOSTIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 MESQUITE AVE
LAKE HAVASU CITY AZ
86403-5602
US

IV. Provider business mailing address

5805 DOE AVE
LAS VEGAS NV
89146-1209
US

V. Phone/Fax

Practice location:
  • Phone: 928-855-1550
  • Fax:
Mailing address:
  • Phone: 702-870-1195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MS. TATYANA WHITE
Title or Position: PRESIDENT
Credential:
Phone: 702-870-1195