Provider Demographics
NPI:1689701138
Name:MOBILE DIAGNOSTIC TEST SERV INC
Entity Type:Organization
Organization Name:MOBILE DIAGNOSTIC TEST SERV INC
Other - Org Name:HEALTHTRAC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-614-3285
Mailing Address - Street 1:4950 GENESEE ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14225-5550
Mailing Address - Country:US
Mailing Address - Phone:716-686-7100
Mailing Address - Fax:716-614-3282
Practice Address - Street 1:1001 STATE ST
Practice Address - Street 2:SUITE 1400
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1814
Practice Address - Country:US
Practice Address - Phone:814-480-5716
Practice Address - Fax:814-480-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00105453Medicare ID - Type UnspecifiedRAILROAD
PA022149Medicare PIN