Provider Demographics
NPI:1144498387
Name:MEDICAL DIAGNOSTIC CENTER INC
Entity type:Organization
Organization Name:MEDICAL DIAGNOSTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOVHANNES
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAGEZYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-795-1555
Mailing Address - Street 1:1020 E PALMDALE ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-3309
Mailing Address - Country:US
Mailing Address - Phone:520-889-7777
Mailing Address - Fax:520-807-3777
Practice Address - Street 1:1020 E PALMDALE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-3309
Practice Address - Country:US
Practice Address - Phone:520-889-7777
Practice Address - Fax:520-807-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTIN