Provider Demographics
NPI:1063096162
Name:MEDTECH DIAGNOSTIC IMAGING LLC
Entity type:Organization
Organization Name:MEDTECH DIAGNOSTIC IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAIHAAN
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-201-4786
Mailing Address - Street 1:1050 MURRIETA BLVD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4111
Mailing Address - Country:US
Mailing Address - Phone:877-470-7531
Mailing Address - Fax:888-706-4887
Practice Address - Street 1:1050 MURRIETA BLVD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4111
Practice Address - Country:US
Practice Address - Phone:877-470-7531
Practice Address - Fax:888-706-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier