Provider Demographics
NPI:1437469004
Name:MOBILE X-RAY SERVICES LLC
Entity Type:Organization
Organization Name:MOBILE X-RAY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-687-6861
Mailing Address - Street 1:9376 MANSFIELD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3181
Mailing Address - Country:US
Mailing Address - Phone:318-687-6861
Mailing Address - Fax:318-687-6768
Practice Address - Street 1:9376 MANSFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3181
Practice Address - Country:US
Practice Address - Phone:318-687-6861
Practice Address - Fax:318-687-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier