Provider Demographics
NPI:1760855043
Name:MIDWEST MOBILE IMAGING
Entity Type:Organization
Organization Name:MIDWEST MOBILE IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-426-9210
Mailing Address - Street 1:PO BOX 4241
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4241
Mailing Address - Country:US
Mailing Address - Phone:888-426-9210
Mailing Address - Fax:888-426-9214
Practice Address - Street 1:2833 E BATTLEFIELD ST STE A100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4084
Practice Address - Country:US
Practice Address - Phone:888-426-9210
Practice Address - Fax:888-426-9214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory