Provider Demographics
NPI:1508943697
Name:MOBILE DIAGNOSTICS PC
Entity Type:Organization
Organization Name:MOBILE DIAGNOSTICS PC
Other - Org Name:PROFESSIONAL CORP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FRAZIER
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:RTR
Authorized Official - Phone:540-248-8477
Mailing Address - Street 1:PO BOX 861
Mailing Address - Street 2:350 LEE HIGHWAY
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482
Mailing Address - Country:US
Mailing Address - Phone:540-248-8477
Mailing Address - Fax:540-248-8478
Practice Address - Street 1:350 LEE HIGHWAY
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482
Practice Address - Country:US
Practice Address - Phone:540-248-8477
Practice Address - Fax:540-248-8478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA224055335V00000X
VA0120002197335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier