Provider Demographics
NPI:1396079760
Name:MOBILE X-RAY SERVICES
Entity type:Organization
Organization Name:MOBILE X-RAY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BERRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-558-9396
Mailing Address - Street 1:3825 S CAMPBELL AVE
Mailing Address - Street 2:PMB # 198
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5339
Mailing Address - Country:US
Mailing Address - Phone:417-863-9729
Mailing Address - Fax:417-863-0720
Practice Address - Street 1:1208 EAGLECREST ST
Practice Address - Street 2:SUITE E
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8458
Practice Address - Country:US
Practice Address - Phone:417-863-9729
Practice Address - Fax:417-863-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000040114261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOGMDM6455-R001Medicaid
MOGMDM6455-R001Medicaid