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General NPI Number Information
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NPI Number | 1396093910
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Entity Type | Organization
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Legal Business Name | MEDICAL SUPPORT SYSTEMS, INC.
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 4400 NW LOOP 410, SUITE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78229
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Country | US
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Telephone | 702-461-6094
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Fax |
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Provider Business Mailing Address
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Address Line | 7251 W. LAKE MEAD BLVD, SUITE 300
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City | LAS VEGAS
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State | NV
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Zip | 89128
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Country | US
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Telephone | 702-461-6094
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. RONALD DIVITO
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Credential | C.P.A., MBA
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Telephone | 702-461-6094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | NV19981366358
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License Number State | NV
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