Provider Demographics
NPI:1306845094
Name:MOBILE MEDICAL DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:MOBILE MEDICAL DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DELKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-777-1363
Mailing Address - Street 1:6223 HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-8175
Mailing Address - Country:US
Mailing Address - Phone:641-777-1363
Mailing Address - Fax:641-682-6836
Practice Address - Street 1:6223 HIGHWAY 63
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-8175
Practice Address - Country:US
Practice Address - Phone:641-777-1363
Practice Address - Fax:641-682-6836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00419261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA45171OtherWELLMARK BC/BS OF IOWA
IA0265850Medicaid
IA630001464OtherRAILROAD MEDICARE
IA48491Medicare ID - Type Unspecified