Provider Demographics
NPI:1538551932
Name:MDS MEDICAL DEVICE SPECIALTY INC.
Entity type:Organization
Organization Name:MDS MEDICAL DEVICE SPECIALTY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-475-0303
Mailing Address - Street 1:270 W 500 N
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-2769
Mailing Address - Country:US
Mailing Address - Phone:801-475-0303
Mailing Address - Fax:888-455-8597
Practice Address - Street 1:5830 MCARDLE RD STE 15
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-3472
Practice Address - Country:US
Practice Address - Phone:888-518-5110
Practice Address - Fax:877-475-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies