Healthcare Provider Details

I. General information

NPI: 1497761795
Provider Name (Legal Business Name): MEDICAL DIAGNOSTIC SERVICES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657A W MAPLE
FARMINGTON NM
87401
US

IV. Provider business mailing address

PO BOX 614
FARMINGTON NM
87499
US

V. Phone/Fax

Practice location:
  • Phone: 505-326-5860
  • Fax: 505-325-0689
Mailing address:
  • Phone: 505-326-5860
  • Fax: 505-325-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES SPENCE
Title or Position: PRESIDENT
Credential: MD
Phone: 505-325-5860