Provider Demographics
NPI:1295369676
Name:MOBILE DIAGNOSTICS
Entity Type:Organization
Organization Name:MOBILE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-779-0606
Mailing Address - Street 1:6424 E GREENWAY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2045
Mailing Address - Country:US
Mailing Address - Phone:480-750-7192
Mailing Address - Fax:480-750-7193
Practice Address - Street 1:6424 E GREENWAY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2045
Practice Address - Country:US
Practice Address - Phone:480-750-7192
Practice Address - Fax:480-750-7193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty