Provider Demographics
NPI:1083686240
Name:MOBILE RAD, LLC
Entity Type:Organization
Organization Name:MOBILE RAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-636-9729
Mailing Address - Street 1:3 CABOT PL
Mailing Address - Street 2:UNIT 9
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-4612
Mailing Address - Country:US
Mailing Address - Phone:800-636-9729
Mailing Address - Fax:781-341-0053
Practice Address - Street 1:1000 E WALNUT ST
Practice Address - Street 2:SUITE 621A
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-5444
Practice Address - Country:US
Practice Address - Phone:215-453-7360
Practice Address - Fax:215-453-7362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile