Provider Demographics
NPI:1689926347
Name:ULTRASCAN MOBILE IMAGING
Entity Type:Organization
Organization Name:ULTRASCAN MOBILE IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:903-330-7840
Mailing Address - Street 1:19 GLENBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:LUCAS
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8401
Mailing Address - Country:US
Mailing Address - Phone:214-687-8657
Mailing Address - Fax:
Practice Address - Street 1:19 GLENBROOK CIR
Practice Address - Street 2:
Practice Address - City:LUCAS
Practice Address - State:TX
Practice Address - Zip Code:75002-8401
Practice Address - Country:US
Practice Address - Phone:214-687-8657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier