Provider Demographics
NPI:1275532632
Name:MOBLIE DIAGNOSTIC IMAGING INC.
Entity Type:Organization
Organization Name:MOBLIE DIAGNOSTIC IMAGING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-452-5638
Mailing Address - Street 1:PO BOX 550819
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-0819
Mailing Address - Country:US
Mailing Address - Phone:954-452-5638
Mailing Address - Fax:954-452-5639
Practice Address - Street 1:12555 ORANGE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4304
Practice Address - Country:US
Practice Address - Phone:954-452-5638
Practice Address - Fax:954-452-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6340261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile