Provider Demographics
NPI:1245843556
Name:MOBILE XRAY DIAGNOSTICS LLC
Entity type:Organization
Organization Name:MOBILE XRAY DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TORTORELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-213-9729
Mailing Address - Street 1:350 BEDFORD ST STE 5A
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-2128
Mailing Address - Country:US
Mailing Address - Phone:774-213-9729
Mailing Address - Fax:508-813-3137
Practice Address - Street 1:350 BEDFORD ST STE 5A
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-2128
Practice Address - Country:US
Practice Address - Phone:774-213-9729
Practice Address - Fax:508-813-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier