Provider Demographics
NPI:1679844963
Name:MICHIGAN MOBILE IMAGING, LLC
Entity Type:Organization
Organization Name:MICHIGAN MOBILE IMAGING, LLC
Other - Org Name:OAKWOOD MICHIGAN MOBIL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-593-7623
Mailing Address - Street 1:15500 LUNDY PKWY
Mailing Address - Street 2:ATTN: TAMMY FLYNN (N201)
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2778
Mailing Address - Country:US
Mailing Address - Phone:313-586-5669
Mailing Address - Fax:313-791-4563
Practice Address - Street 1:15500 LUNDY PKWY
Practice Address - Street 2:ATTN: TAMMY FLYNN (N201)
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2778
Practice Address - Country:US
Practice Address - Phone:313-586-5669
Practice Address - Fax:313-791-4563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty