Provider Demographics
NPI:1548466295
Name:MALLARD MEDICAL SERVICES INC
Entity type:Organization
Organization Name:MALLARD MEDICAL SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:RASHEED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-255-6651
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:STANAFORD
Mailing Address - State:WV
Mailing Address - Zip Code:25927-0012
Mailing Address - Country:US
Mailing Address - Phone:304-255-6651
Mailing Address - Fax:
Practice Address - Street 1:20 MALLARD CT
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3615
Practice Address - Country:US
Practice Address - Phone:304-255-6651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MALLARD MEDICAL SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-21
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5580091000Medicaid
WV51D0235339OtherCLIA