Provider Demographics
NPI:1992856488
Name:MOBILE X-RAY SERVICES OF SHREVEPORT BOSSIER INC
Entity Type:Organization
Organization Name:MOBILE X-RAY SERVICES OF SHREVEPORT BOSSIER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-687-6861
Mailing Address - Street 1:670 ALBEMARLE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-5946
Mailing Address - Country:US
Mailing Address - Phone:318-687-6861
Mailing Address - Fax:318-687-6768
Practice Address - Street 1:670 ALBEMARLE DR STE 202
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-5946
Practice Address - Country:US
Practice Address - Phone:318-687-6861
Practice Address - Fax:318-687-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA630000359OtherRR MEDICARE PROVIDER NUMB
LA1317497Medicaid
LA13066OtherBC BS PROVIDER NUMBER
LA19803Medicare PIN