Provider Demographics
NPI:1710219167
Name:MOBILE IMAGING OF ST LUCIE COUNTY INC
Entity Type:Organization
Organization Name:MOBILE IMAGING OF ST LUCIE COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-569-9729
Mailing Address - Street 1:120 66TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-9706
Mailing Address - Country:US
Mailing Address - Phone:772-569-9729
Mailing Address - Fax:772-569-2769
Practice Address - Street 1:120 66TH AVE SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-9706
Practice Address - Country:US
Practice Address - Phone:772-569-9729
Practice Address - Fax:772-569-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5034261QR0208X
293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile