Provider Demographics
NPI:1679722615
Name:SIMPLY MOBILE X-RAY INC
Entity Type:Organization
Organization Name:SIMPLY MOBILE X-RAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:928-261-6379
Mailing Address - Street 1:3661 W 12TH LN
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-9107
Mailing Address - Country:US
Mailing Address - Phone:928-261-6379
Mailing Address - Fax:928-276-4834
Practice Address - Street 1:3661 W 12TH LN
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-9107
Practice Address - Country:US
Practice Address - Phone:928-261-6379
Practice Address - Fax:928-276-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHT 92930335V00000X
AZCRT-14994335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00733483OtherMEDICARE RAILROAD CARRIER
AZ443363Medicaid
AZP00733483OtherMEDICARE RAILROAD CARRIER
AZZ126528Medicare PIN