Provider Demographics
NPI:1639504244
Name:MIRI PHILLIPS MOBILE IMAGING INC
Entity Type:Organization
Organization Name:MIRI PHILLIPS MOBILE IMAGING INC
Other - Org Name:MIRI - PHILLIPS MOBILE IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR / CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-999-7770
Mailing Address - Street 1:5042 WILSHIRE BLVD
Mailing Address - Street 2:505
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4305
Mailing Address - Country:US
Mailing Address - Phone:213-999-7770
Mailing Address - Fax:866-505-1544
Practice Address - Street 1:5042 WILSHIRE BLVD
Practice Address - Street 2:505
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4305
Practice Address - Country:US
Practice Address - Phone:213-999-7770
Practice Address - Fax:866-505-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier