Provider Demographics
NPI:1619626249
Name:MOBILE XRAY SERVICE LLC
Entity Type:Organization
Organization Name:MOBILE XRAY SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOGAPHER
Authorized Official - Prefix:
Authorized Official - First Name:LAMARE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT (R) (CT)(R)
Authorized Official - Phone:314-584-9330
Mailing Address - Street 1:10 NOB HILL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-1458
Mailing Address - Country:US
Mailing Address - Phone:314-584-9330
Mailing Address - Fax:
Practice Address - Street 1:10 NOB HILL DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-1458
Practice Address - Country:US
Practice Address - Phone:314-584-9330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty