Provider Demographics
NPI:1790549152
Name:MEDICAL MOBILE IMAGING, LLC
Entity Type:Organization
Organization Name:MEDICAL MOBILE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)(CT)
Authorized Official - Phone:801-710-9023
Mailing Address - Street 1:972 CHAMBERS ST STE 7
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4873
Mailing Address - Country:US
Mailing Address - Phone:801-710-9023
Mailing Address - Fax:
Practice Address - Street 1:972 CHAMBERS ST STE 7
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4873
Practice Address - Country:US
Practice Address - Phone:801-710-9023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile