Provider Demographics
NPI:1093756843
Name:MOBILE RADIOLOGY LABS, INC
Entity Type:Organization
Organization Name:MOBILE RADIOLOGY LABS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:TARVER
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:301-782-2377
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:VA
Mailing Address - Zip Code:20116-0520
Mailing Address - Country:US
Mailing Address - Phone:301-782-2377
Mailing Address - Fax:301-782-7724
Practice Address - Street 1:1 RESEARCH CT
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6222
Practice Address - Country:US
Practice Address - Phone:301-782-2377
Practice Address - Fax:301-782-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD434227500Medicaid
VA298514OtherANTHEM
VA298514OtherANTHEM
DCFDX027Medicare PIN