Provider Demographics
NPI:1043863525
Name:MOBILITY DX, LLC
Entity Type:Organization
Organization Name:MOBILITY DX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:M
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R) (CT) (CIIP)
Authorized Official - Phone:408-373-6176
Mailing Address - Street 1:1372 MEADOW CREST DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7413
Mailing Address - Country:US
Mailing Address - Phone:408-373-6176
Mailing Address - Fax:
Practice Address - Street 1:1372 MEADOW CREST DR
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7413
Practice Address - Country:US
Practice Address - Phone:408-373-6176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier