Provider Demographics
NPI:1467459743
Name:ATLANTIC MOBILE IMAGING SERVICES, INC.
Entity Type:Organization
Organization Name:ATLANTIC MOBILE IMAGING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:B
Authorized Official - Last Name:THURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-329-8270
Mailing Address - Street 1:1400 HAND AVE, STE A
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-239-8270
Mailing Address - Fax:386-239-8273
Practice Address - Street 1:1400 HAND AVE STE A
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8195
Practice Address - Country:US
Practice Address - Phone:386-239-8270
Practice Address - Fax:386-239-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6683335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL510012700Medicaid
FL630001722OtherMEDICARE RAILROAD
FLHCC6683OtherAHCA
U3821Medicare UPIN
FL510012700Medicaid