Provider Demographics
NPI:1639273709
Name:MOBILE MEDICAL IMAGING SERVICES INC
Entity Type:Organization
Organization Name:MOBILE MEDICAL IMAGING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:207-774-0720
Mailing Address - Street 1:1601 CONGRESS STREET SUITE 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2141
Mailing Address - Country:US
Mailing Address - Phone:207-774-0885
Mailing Address - Fax:207-774-7694
Practice Address - Street 1:1601 CONGRESS STREET SUITE 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2141
Practice Address - Country:US
Practice Address - Phone:207-774-0885
Practice Address - Fax:207-774-7694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME623279OtherHARVARD PILGRIM
ME025008OtherBLUE CROSS/BLUE SHIELD
ME115380000Medicaid
ME014369Medicare ID - Type Unspecified