Provider Demographics
NPI:1407936693
Name:BIOTECH X-RAY, INC.
Entity Type:Organization
Organization Name:BIOTECH X-RAY, INC.
Other - Org Name:MOBILE MEDICAL DIAGNOSTICS OF LACROSSE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP COMPLIANCE & INTERNAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-909-9729
Mailing Address - Street 1:2895 ALGOMA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-1012
Mailing Address - Country:US
Mailing Address - Phone:920-230-9729
Mailing Address - Fax:920-230-2061
Practice Address - Street 1:2895 ALGOMA BLVD STE C
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-1012
Practice Address - Country:US
Practice Address - Phone:920-230-9729
Practice Address - Fax:920-230-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN337365700Medicaid
MN39L01MOOtherBC/BS OF MN
MN126531OtherUCARE OF MN
WI42507900Medicaid
MN630000008Medicare ID - Type Unspecified
WI42507900Medicaid
MN39L01MOOtherBC/BS OF MN
MN337365700Medicaid