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General NPI Number Information
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NPI Number | 1700814381
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Entity Type | Organization
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Legal Business Name | MID-WEST DIAGNOSTICS, INC.
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 401 N BRAND BLVD STE 750
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City | GLENDALE
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State | CA
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Zip | 91203-4450
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Country | US
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Telephone | 818-550-9999
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Fax | 818-550-9996
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Provider Business Mailing Address
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Address Line | PO BOX 4064
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City | GLENDALE
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State | CA
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Zip | 91222-0064
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Country | US
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Telephone | 818-550-9999
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Fax | 818-550-9996
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SHAKE K. SEYSYAN
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Credential |
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Telephone | 818-550-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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