Provider Demographics
NPI:1457603151
Name:RELIANCE MOBILE DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:RELIANCE MOBILE DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAI
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-841-1113
Mailing Address - Street 1:1666 N HAMPTON RD
Mailing Address - Street 2:105
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2390
Mailing Address - Country:US
Mailing Address - Phone:972-841-1113
Mailing Address - Fax:214-666-9862
Practice Address - Street 1:1666 N HAMPTON RD
Practice Address - Street 2:105
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2390
Practice Address - Country:US
Practice Address - Phone:972-841-1113
Practice Address - Fax:214-666-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty