Provider Demographics
NPI:1558391540
Name:MOBILE SONIX LLC
Entity Type:Organization
Organization Name:MOBILE SONIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-339-7717
Mailing Address - Street 1:PO BOX 947951
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-7951
Mailing Address - Country:US
Mailing Address - Phone:407-339-7717
Mailing Address - Fax:321-445-5559
Practice Address - Street 1:13059 PENSHURST LN
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6671
Practice Address - Country:US
Practice Address - Phone:407-339-7717
Practice Address - Fax:321-445-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7053261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL510057700Medicaid
FL510057700Medicaid