Provider Demographics
NPI:1114969722
Name:MOBILE GROUP, INC
Entity Type:Organization
Organization Name:MOBILE GROUP, INC
Other - Org Name:MOBILABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-207-7699
Mailing Address - Street 1:2970 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9451
Mailing Address - Country:US
Mailing Address - Phone:269-544-2295
Mailing Address - Fax:
Practice Address - Street 1:2970 S 9TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9451
Practice Address - Country:US
Practice Address - Phone:269-544-2295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP03800Medicare ID - Type UnspecifiedIDTF