Provider Demographics
NPI:1326225236
Name:STAT MOBILE DIAGNOSTICS INC
Entity Type:Organization
Organization Name:STAT MOBILE DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT
Authorized Official - Phone:305-621-7772
Mailing Address - Street 1:2221 NE 164TH ST
Mailing Address - Street 2:#290
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3703
Mailing Address - Country:US
Mailing Address - Phone:305-621-7772
Mailing Address - Fax:
Practice Address - Street 1:18350 NW 2ND AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4519
Practice Address - Country:US
Practice Address - Phone:305-621-7772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5747261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2241OtherMEDICARE PTAN