Provider Demographics
NPI:1205840063
Name:MOBILE DIAGNOSTIC IMAGING LLC
Entity Type:Organization
Organization Name:MOBILE DIAGNOSTIC IMAGING LLC
Other - Org Name:MDI MOBILE ULTRASOUND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:G
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:WEES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-266-4908
Mailing Address - Street 1:120 SPRINGDALE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-4133
Mailing Address - Country:US
Mailing Address - Phone:740-266-4908
Mailing Address - Fax:740-264-4376
Practice Address - Street 1:120 SPRINGDALE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-4133
Practice Address - Country:US
Practice Address - Phone:740-266-4908
Practice Address - Fax:740-264-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPENDING247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX IDENTIFICATION NUMBER