Healthcare Provider Details

I. General information

NPI: 1457305856
Provider Name (Legal Business Name): MEDICAL DIAGNOSTIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 MOUNTAIN VISTA ST. SUITE 101
HENDERSON NV
89014-2631
US

IV. Provider business mailing address

6301 MOUNTAIN VISTA ST. SUITE 101
HENDERSON NV
89014-2631
US

V. Phone/Fax

Practice location:
  • Phone: 702-777-1200
  • Fax: 702-933-4289
Mailing address:
  • Phone: 702-940-2650
  • Fax: 702-933-4289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREG CHRISTOPHERSON
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 702-940-2629