Provider Demographics
NPI:1407505100
Name:MOBILE MEDICAL DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:MOBILE MEDICAL DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGY TECH/SONOGRAPHY
Authorized Official - Prefix:
Authorized Official - First Name:MAKENZIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:TEICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-737-4206
Mailing Address - Street 1:10869 N SCOTTSDALE RD PMB602 SCOTTSDALE, AZ 8 STE 103
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10869 N SCOTTSDALE RD PMB602 SCOTTSDALE, AZ 8 STE 103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:480-737-4206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile