Provider Demographics
NPI:1518027507
Name:DIAGNOSTIC MOBILE XRAY OF ENID
Entity Type:Organization
Organization Name:DIAGNOSTIC MOBILE XRAY OF ENID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-330-0055
Mailing Address - Street 1:PO BOX 3637
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-3637
Mailing Address - Country:US
Mailing Address - Phone:405-330-0055
Mailing Address - Fax:
Practice Address - Street 1:247 S COLTRANE RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6730
Practice Address - Country:US
Practice Address - Phone:405-330-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier