Provider Demographics
NPI:1093953150
Name:SHULER MOBILE X-RAY SERVICE
Entity Type:Organization
Organization Name:SHULER MOBILE X-RAY SERVICE
Other - Org Name:EDDIE T SHULER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:REGISTERED X-RAY TECHNOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHULER RT( R )
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-477-5366
Mailing Address - Street 1:3421 KAY ST
Mailing Address - Street 2:SUITE U5
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5373
Mailing Address - Country:US
Mailing Address - Phone:803-477-5366
Mailing Address - Fax:
Practice Address - Street 1:3421 KAY ST
Practice Address - Street 2:SUITE U5
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5373
Practice Address - Country:US
Practice Address - Phone:803-477-5366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHULER MOBILE X-RAY SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00-2769 X-RAY TECH252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427201789OtherINDIVIDUAL NPI #