Provider Demographics
NPI:1417279258
Name:3D MOBILE IMAGING LLC
Entity Type:Organization
Organization Name:3D MOBILE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:VESSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-751-7552
Mailing Address - Street 1:2501 E 1704TH RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-9331
Mailing Address - Country:US
Mailing Address - Phone:309-751-7552
Mailing Address - Fax:
Practice Address - Street 1:2501 E 1704TH RD
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-9331
Practice Address - Country:US
Practice Address - Phone:309-751-7552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL9259150261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile