Provider Demographics
NPI:1215204821
Name:BAY AREA MOBILE, INC
Entity Type:Organization
Organization Name:BAY AREA MOBILE, INC
Other - Org Name:AXIOM MOBILE IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-377-0325
Mailing Address - Street 1:751 LAUREL ST # 202
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3113
Mailing Address - Country:US
Mailing Address - Phone:415-377-0325
Mailing Address - Fax:866-846-1907
Practice Address - Street 1:751 LAUREL ST # 202
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3113
Practice Address - Country:US
Practice Address - Phone:415-377-0325
Practice Address - Fax:866-846-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFAC 70472335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFS595AOtherMEDICARE PTAN
CAFAC00070472Medicaid