Provider Demographics
NPI:1073741674
Name:MOBILE IMAGING ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MOBILE IMAGING ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DIVYANG
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-484-8100
Mailing Address - Street 1:3013 RAEFORD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5441
Mailing Address - Country:US
Mailing Address - Phone:910-484-8100
Mailing Address - Fax:910-484-8105
Practice Address - Street 1:3013 RAEFORD RD
Practice Address - Street 2:SUITE A
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5441
Practice Address - Country:US
Practice Address - Phone:910-484-8100
Practice Address - Fax:910-484-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02611221261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile