Provider Demographics
NPI:1407163843
Name:MEDMOBILE IMAGING , LLC
Entity Type:Organization
Organization Name:MEDMOBILE IMAGING , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:469-877-9417
Mailing Address - Street 1:4201 STONE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-7289
Mailing Address - Country:US
Mailing Address - Phone:469-877-9417
Mailing Address - Fax:972-303-1620
Practice Address - Street 1:1350 N BUCKNER BLVD STE 212
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3575
Practice Address - Country:US
Practice Address - Phone:469-877-9417
Practice Address - Fax:972-303-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier