Provider Demographics
NPI:1043511231
Name:FOUNDATION HEALTH MOBILE IMAGING, LLC
Entity Type:Organization
Organization Name:FOUNDATION HEALTH MOBILE IMAGING, LLC
Other - Org Name:FOUNDATION MOBILE 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-300-0101
Mailing Address - Street 1:P.O. BOX 933559
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-3559
Mailing Address - Country:US
Mailing Address - Phone:336-659-1211
Mailing Address - Fax:336-774-1751
Practice Address - Street 1:2000 WELLNESS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-7764
Practice Address - Country:US
Practice Address - Phone:704-316-1180
Practice Address - Fax:704-316-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty