Provider Demographics
NPI:1104834258
Name:MOBILE CR IMAGING, LLC
Entity Type:Organization
Organization Name:MOBILE CR IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:II
Authorized Official - Credentials:RT(R)
Authorized Official - Phone:844-321-9729
Mailing Address - Street 1:4749 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-3710
Mailing Address - Country:US
Mailing Address - Phone:844-321-9729
Mailing Address - Fax:512-233-5966
Practice Address - Street 1:4749 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633
Practice Address - Country:US
Practice Address - Phone:844-321-9729
Practice Address - Fax:512-233-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178311003Medicaid