Provider Demographics
NPI:1710982004
Name:ULTRA MOBILE X-RAY INC
Entity Type:Organization
Organization Name:ULTRA MOBILE X-RAY INC
Other - Org Name:ULTRA MOBILE IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUNEER
Authorized Official - Middle Name:
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-544-1249
Mailing Address - Street 1:1001 N FEDERAL HWY
Mailing Address - Street 2:SUITE 234
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2408
Mailing Address - Country:US
Mailing Address - Phone:954-404-7815
Mailing Address - Fax:305-887-7340
Practice Address - Street 1:1001 N FEDERAL HWY
Practice Address - Street 2:SUITE 234
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2408
Practice Address - Country:US
Practice Address - Phone:954-404-7815
Practice Address - Fax:305-887-7340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002725400Medicaid
FL630000808OtherRAILROAD
FL002725400Medicaid