Provider Demographics
NPI:1629154372
Name:RESIDENTS' CHOICE MOBILE X-RAY
Entity Type:Organization
Organization Name:RESIDENTS' CHOICE MOBILE X-RAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIN OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-751-5688
Mailing Address - Street 1:20600 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5327
Mailing Address - Country:US
Mailing Address - Phone:216-751-5688
Mailing Address - Fax:216-751-5749
Practice Address - Street 1:20600 CHAGRIN BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5327
Practice Address - Country:US
Practice Address - Phone:216-751-5688
Practice Address - Fax:216-751-5749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2564505Medicaid
3698721Medicare ID - Type Unspecified