Provider Demographics
NPI:1639607575
Name:MOBILE X-RAY SPECIALISTS, INC.
Entity Type:Organization
Organization Name:MOBILE X-RAY SPECIALISTS, INC.
Other - Org Name:MOBILE IMAGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R) ARRT
Authorized Official - Phone:877-887-3829
Mailing Address - Street 1:PO BOX 521292
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32752-1292
Mailing Address - Country:US
Mailing Address - Phone:877-887-3829
Mailing Address - Fax:888-405-0653
Practice Address - Street 1:6706 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-9303
Practice Address - Country:US
Practice Address - Phone:877-887-3829
Practice Address - Fax:888-405-0653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0303071-00Medicaid