Provider Demographics
NPI:1407038300
Name:MOBILE DIAGNOSTIC SOLUTIONS, LLC
Entity Type:Organization
Organization Name:MOBILE DIAGNOSTIC SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-694-2813
Mailing Address - Street 1:1702 PRAIRIE LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-1412
Mailing Address - Country:US
Mailing Address - Phone:407-694-2813
Mailing Address - Fax:407-522-9753
Practice Address - Street 1:1702 PRAIRIE LAKE BLVD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-1412
Practice Address - Country:US
Practice Address - Phone:407-694-2813
Practice Address - Fax:407-522-9753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3100-1038230261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service