MEDICARE: MEDICAL DIAGNOSTIC SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457305856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL DIAGNOSTIC SERVICES, INC.

Provider Business Mailing Address
First Line	:	6301 MOUNTAIN VISTA ST.
Second Line	:	SUITE 101
City	:	HENDERSON
State	:	NV
Zip	:	89014-2631
Country	:	US
Telephone Number	:	702-940-2650
Fax Number	:	702-933-4289

Provider Business Practice Location Address
First Line	:	6301 MOUNTAIN VISTA ST.
Second Line	:	SUITE 101
City	:	HENDERSON
State	:	NV
Zip	:	89014-2631
Country	:	US
Telephone Number	:	702-777-1200
Fax Number	:	702-933-4289

Authorized Official
Title or Position	:	OPERATIONS DIRECTOR
Name	:	GREG CHRISTOPHERSON
Credential	:
Telephone Number	:	702-940-2629

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	09/29/2009

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