Provider Demographics
NPI:1295041416
Name:PROFESSIONAL MOBILE DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL MOBILE DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-608-6380
Mailing Address - Street 1:2600 SW 126TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2129
Mailing Address - Country:US
Mailing Address - Phone:305-608-6380
Mailing Address - Fax:305-662-5965
Practice Address - Street 1:2600 SW 126TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2129
Practice Address - Country:US
Practice Address - Phone:305-608-6380
Practice Address - Fax:305-662-5965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2471V0105X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization