Provider Demographics
NPI:1609272236
Name:EZ MOBILE DIAGNOSTIC SERVICES MANAGEMENT INC
Entity Type:Organization
Organization Name:EZ MOBILE DIAGNOSTIC SERVICES MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGASYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-975-7977
Mailing Address - Street 1:3401 CUSTER RD
Mailing Address - Street 2:STE 170
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-7599
Mailing Address - Country:US
Mailing Address - Phone:972-975-7977
Mailing Address - Fax:214-299-9329
Practice Address - Street 1:3401 CUSTER RD
Practice Address - Street 2:STE 170
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-7599
Practice Address - Country:US
Practice Address - Phone:972-975-7977
Practice Address - Fax:214-299-9329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile