Organization
M DS CYBER CLINIC PA
Active
Other names
Northwest Diagnostic Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BRUCE BOGDANOVICH MD (PRESIDENT)
(512) 250-3900
Entity
Organization
Contact information
Practice address
500 W WHITESTONE BLVD, SUITE 100, CEDAR PARK, TX 78613-2245
(512) 250-3900
(512) 249-6232
Mailing address
500 W WHITESTONE BLVD, SUITE 100, CEDAR PARK, TX 78613-2245
(512) 250-3900
(512) 249-6232
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
H6779
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00769N
MEDICARE PTAN
TX
Enumeration date
06/30/2006
Last updated
01/04/2013
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