Provider Demographics
NPI:1770688830
Name:MOBILE DIAGNOSTICS OF LEON COUNTY
Entity Type:Organization
Organization Name:MOBILE DIAGNOSTICS OF LEON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:ROWE
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-878-7422
Mailing Address - Street 1:2208 NAPOLEON BONAPARTE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5917
Mailing Address - Country:US
Mailing Address - Phone:850-933-1024
Mailing Address - Fax:850-877-9953
Practice Address - Street 1:2208 NAPOLEON BONAPARTE DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5917
Practice Address - Country:US
Practice Address - Phone:850-933-1024
Practice Address - Fax:850-877-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLW9848Medicare ID - Type UnspecifiedPORTABLE X-RAY