Provider Demographics
NPI:1417283060
Name:MOBILE RADIOLOGY INC.
Entity Type:Organization
Organization Name:MOBILE RADIOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:956-440-9729
Mailing Address - Street 1:17745 W EXPRESSWAY 83
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-3536
Mailing Address - Country:US
Mailing Address - Phone:956-440-9729
Mailing Address - Fax:956-440-8882
Practice Address - Street 1:17745 W EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3536
Practice Address - Country:US
Practice Address - Phone:956-440-9729
Practice Address - Fax:956-440-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR23048293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086113003Medicaid
TXFTXU51Medicare PIN