Provider Demographics
NPI:1982743837
Name:MEDICAL DIAGNOSTIC NETWORK, INC.
Entity type:Organization
Organization Name:MEDICAL DIAGNOSTIC NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-745-5450
Mailing Address - Street 1:PO BOX 4633
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-1024
Mailing Address - Country:US
Mailing Address - Phone:561-745-5450
Mailing Address - Fax:561-972-7565
Practice Address - Street 1:184 GOLFVIEW DR
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-1921
Practice Address - Country:US
Practice Address - Phone:561-745-5450
Practice Address - Fax:561-972-7565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4668291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory