Provider Demographics
NPI:1598719635
Name:QUALITY MOBILE XRAY SERVICES INC
Entity Type:Organization
Organization Name:QUALITY MOBILE XRAY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-371-0073
Mailing Address - Street 1:PO BOX 110359
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37222-0359
Mailing Address - Country:US
Mailing Address - Phone:615-391-4515
Mailing Address - Fax:303-785-9283
Practice Address - Street 1:640 GRASSMERE PARK
Practice Address - Street 2:SUITE 116
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3678
Practice Address - Country:US
Practice Address - Phone:615-391-4515
Practice Address - Fax:303-785-9283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY86000056Medicaid
AR5G608Medicare PIN
KY86000056Medicaid
TN3402520Medicare PIN