Provider Demographics
NPI:1427184845
Name:MOBILERAY INC
Entity Type:Organization
Organization Name:MOBILERAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:EMERY
Authorized Official - Middle Name:EARLE
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:RT-R
Authorized Official - Phone:910-488-7752
Mailing Address - Street 1:1886 GOLA DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-0522
Mailing Address - Country:US
Mailing Address - Phone:910-488-7752
Mailing Address - Fax:910-221-7037
Practice Address - Street 1:1886 GOLA DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-0522
Practice Address - Country:US
Practice Address - Phone:910-488-7752
Practice Address - Fax:910-221-7037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC285746247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH220NMEDCAREPROOtherANTHEM BLUE CROSS AND BLU
NC0181YOtherBLUECROSS BLUE SHIELD OF
NC3409818Medicaid
OH220NMEDCAREPROOtherANTHEM BLUE CROSS AND BLU
OH220NMEDCAREPROOtherANTHEM BLUE CROSS AND BLU