Provider Demographics
NPI:1851540173
Name:PROFESSIONAL XRAY MOBILITY LLC
Entity Type:Organization
Organization Name:PROFESSIONAL XRAY MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:COODEY
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R)
Authorized Official - Phone:405-819-5308
Mailing Address - Street 1:14700 S HARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7224
Mailing Address - Country:US
Mailing Address - Phone:405-819-5308
Mailing Address - Fax:
Practice Address - Street 1:14700 S HARVEY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-7224
Practice Address - Country:US
Practice Address - Phone:405-819-5308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier