Provider Demographics
NPI:1962523696
Name:MDS DIGITAL PORTABLE X-RAY INC
Entity type:Organization
Organization Name:MDS DIGITAL PORTABLE X-RAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUNEER
Authorized Official - Middle Name:
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-544-1249
Mailing Address - Street 1:10300 W LINCOLN AVE
Mailing Address - Street 2:SUITE LL
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2100
Mailing Address - Country:US
Mailing Address - Phone:414-321-6666
Mailing Address - Fax:888-734-0535
Practice Address - Street 1:10300 W LINCOLN AVE
Practice Address - Street 2:SUITE LL
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2100
Practice Address - Country:US
Practice Address - Phone:414-321-6666
Practice Address - Fax:888-734-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI291U00000X
WIXM 111590335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42508600Medicaid
WI42508600Medicaid