Provider Demographics
NPI:1265489066
Name:MOBILE MEDICAL RESOURCES, INC.
Entity Type:Organization
Organization Name:MOBILE MEDICAL RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-781-6412
Mailing Address - Street 1:880 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-4350
Mailing Address - Country:US
Mailing Address - Phone:859-781-6412
Mailing Address - Fax:859-781-5333
Practice Address - Street 1:880 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-4350
Practice Address - Country:US
Practice Address - Phone:859-781-6412
Practice Address - Fax:859-781-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHR2343884247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000113213OtherBLUE CROSS PROVIDER NUMBE
OH2217658Medicaid
KY86000007Medicaid
630001613OtherRAILROAD MEDICARE PROVIDE
OH2217658Medicaid
KY86000007Medicaid
630001613OtherRAILROAD MEDICARE PROVIDE