Provider Demographics
NPI:1811389950
Name:MOBILE PVD, LLC
Entity Type:Organization
Organization Name:MOBILE PVD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-912-8858
Mailing Address - Street 1:3109 STIRLING RD
Mailing Address - Street 2:100-B
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6558
Mailing Address - Country:US
Mailing Address - Phone:954-315-2002
Mailing Address - Fax:954-337-2402
Practice Address - Street 1:3109 STIRLING RD
Practice Address - Street 2:100-B
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6558
Practice Address - Country:US
Practice Address - Phone:954-315-2002
Practice Address - Fax:954-337-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile