Provider Demographics
NPI:1669675559
Name:APMJ INC MOBILE DIAGNOSTICS
Entity Type:Organization
Organization Name:APMJ INC MOBILE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-477-0942
Mailing Address - Street 1:PO BOX 173248
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003-3248
Mailing Address - Country:US
Mailing Address - Phone:817-477-0942
Mailing Address - Fax:817-477-4967
Practice Address - Street 1:1401 CRESTVIEW LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5543
Practice Address - Country:US
Practice Address - Phone:817-477-0942
Practice Address - Fax:817-477-4967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTA061Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER