Healthcare Provider Details

I. General information

NPI: 1669419784
Provider Name (Legal Business Name): MEDICAL DIAGNOSTIC SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N. WARD BLVD. SUITE A
WILSON NC
27894
US

IV. Provider business mailing address

P.O. BOX 63
WILSON NC
27894
US

V. Phone/Fax

Practice location:
  • Phone: 252-237-0848
  • Fax: 252-237-0848
Mailing address:
  • Phone: 252-237-0848
  • Fax: 252-237-0848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK HOOPER
Title or Position: OWNER
Credential: DC
Phone: 252-237-0848