Provider Demographics
NPI:1104982719
Name:APEX DIAGNOSTIC SERVICES, INC.
Entity type:Organization
Organization Name:APEX DIAGNOSTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-870-1195
Mailing Address - Street 1:5805 DOE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1209
Mailing Address - Country:US
Mailing Address - Phone:702-870-1195
Mailing Address - Fax:
Practice Address - Street 1:1720 MESQUITE AVE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5602
Practice Address - Country:US
Practice Address - Phone:928-855-1550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APEX DIAGNOSTIC SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-28
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ934027OtherAHCCCS (AZ MEDICAID)
AZ108856Medicare ID - Type UnspecifiedNORIDIAN PROVIDER NUMBER