Healthcare Provider Details

I. General information

NPI: 1881117505
Provider Name (Legal Business Name): MED SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15720 VENTURA BLVD 220
ENCINO CA
91436
US

IV. Provider business mailing address

15720 VENTURA BLVD STE 220
ENCINO CA
91436-2970
US

V. Phone/Fax

Practice location:
  • Phone: 800-967-3309
  • Fax: 800-967-1138
Mailing address:
  • Phone: 800-967-3309
  • Fax: 800-967-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberG36245
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberA84921
License Number StateCA

VIII. Authorized Official

Name: JONATHAN YAKER
Title or Position: MANAGER
Credential:
Phone: 800-967-3309