Basic Information
| Provider Information | |||||||||
| NPI: | 1336420140 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MDINR, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19387 US HIGHWAY 19 N | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337643102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275307700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1718 STONE AVE STE B | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951251333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008774910 | ||||||||
| FaxNumber: | 4089550162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2011 | ||||||||
| LastUpdateDate: | 07/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCCARTHY | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATIONS OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7275307700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | AO | ||||||||
| NPICertificationDate: | 07/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | CA129226 | 01 | CA | IDTF PTAN | OTHER |