Provider Demographics
NPI:1417265174
Name:MOBILE X-RAYS ON DEMAND LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:MOBILE X-RAYS ON DEMAND LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAGOBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-972-0400
Mailing Address - Street 1:3300 BUDDY OWENS BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5270
Mailing Address - Country:US
Mailing Address - Phone:956-972-0400
Mailing Address - Fax:956-972-0402
Practice Address - Street 1:3300 BUDDY OWENS BLVD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5270
Practice Address - Country:US
Practice Address - Phone:956-972-0400
Practice Address - Fax:956-972-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR34526335V00000X
TX335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3088999Medicaid
TXR34526OtherXRAY REGISTRATION
TXR34526OtherX-RAYS REGISTRATION
TXR34526OtherX-RAYS REGISTRATION