Provider Demographics
NPI:1851949291
Name:DR MOBILE IMAGING, LLC
Entity Type:Organization
Organization Name:DR MOBILE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVIN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MODISETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-475-0690
Mailing Address - Street 1:23 WESTHAVEN PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1758
Mailing Address - Country:US
Mailing Address - Phone:731-803-1078
Mailing Address - Fax:731-435-3385
Practice Address - Street 1:23 WESTHAVEN PL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1758
Practice Address - Country:US
Practice Address - Phone:731-803-1078
Practice Address - Fax:731-435-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier