Provider Demographics
NPI:1346332392
Name:MOBILE RADIOLOGY & IMAG
Entity Type:Organization
Organization Name:MOBILE RADIOLOGY & IMAG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:F
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-568-4440
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-0959
Mailing Address - Country:US
Mailing Address - Phone:206-568-4440
Mailing Address - Fax:206-720-4403
Practice Address - Street 1:861 POPLAR PL S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2827
Practice Address - Country:US
Practice Address - Phone:206-568-4440
Practice Address - Fax:206-720-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7000235Medicaid
WA7000235Medicaid
WAG000104763Medicare PIN