Provider Demographics
NPI:1629158746
Name:EXPRESS MOBIL X-RAY INC
Entity Type:Organization
Organization Name:EXPRESS MOBIL X-RAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RADIOGRAPHER
Authorized Official - Phone:832-338-4552
Mailing Address - Street 1:PO BOX 2355
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627
Mailing Address - Country:US
Mailing Address - Phone:832-338-4552
Mailing Address - Fax:512-868-8882
Practice Address - Street 1:219 DUCK CREEK LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-4114
Practice Address - Country:US
Practice Address - Phone:832-338-4552
Practice Address - Fax:866-232-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00241286OtherMEDICARE RAILROAD
TX086089201Medicaid
TXP00241286OtherMEDICARE RAILROAD