Provider Demographics
NPI:1609980184
Name:ELITE MOBILE RADIOLOGY & EKG SERVICE, INC
Entity Type:Organization
Organization Name:ELITE MOBILE RADIOLOGY & EKG SERVICE, INC
Other - Org Name:ELITE MOBILE X-RAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TROKE
Authorized Official - Suffix:
Authorized Official - Credentials:X-RAY TECH
Authorized Official - Phone:775-690-9729
Mailing Address - Street 1:PO BOX 50538
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89435-0538
Mailing Address - Country:US
Mailing Address - Phone:775-690-9729
Mailing Address - Fax:775-851-2797
Practice Address - Street 1:1250 EL MONTE CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4117
Practice Address - Country:US
Practice Address - Phone:775-690-9729
Practice Address - Fax:775-851-2797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV167099335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVY04986Medicare UPIN
NVV38619Medicare ID - Type Unspecified