Provider Demographics
NPI:1639566011
Name:MOBILE X-RAY SERVICES
Entity Type:Organization
Organization Name:MOBILE X-RAY SERVICES
Other - Org Name:KOSMA MOBILE X-RAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAES
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:417-863-9729
Mailing Address - Street 1:3050 N. 20TH STREET
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-5925
Mailing Address - Country:US
Mailing Address - Phone:417-863-9729
Mailing Address - Fax:417-863-0720
Practice Address - Street 1:3050 N. 20TH STREET
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-5925
Practice Address - Country:US
Practice Address - Phone:417-863-9729
Practice Address - Fax:417-863-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory