Provider Demographics
NPI:1407950199
Name:MOBILE VISIONS INS
Entity Type:Organization
Organization Name:MOBILE VISIONS INS
Other - Org Name:QUALITY MOBILE XRAY EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-462-4717
Mailing Address - Street 1:7820 N POINT BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3299
Mailing Address - Country:US
Mailing Address - Phone:336-245-0647
Mailing Address - Fax:336-245-0649
Practice Address - Street 1:7820 N POINT BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3299
Practice Address - Country:US
Practice Address - Phone:336-245-0647
Practice Address - Fax:336-245-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00241101OtherMEDICARE RAILROAD ID NUMB
NC3409806Medicaid
NCP00241101OtherMEDICARE RAILROAD ID NUMB
NCP00241101OtherMEDICARE RAILROAD ID NUMB