Provider Demographics
NPI:1720272941
Name:QUALITY MOBILE IMAGING LLC
Entity Type:Organization
Organization Name:QUALITY MOBILE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-999-9709
Mailing Address - Street 1:501 5TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1900
Mailing Address - Country:US
Mailing Address - Phone:304-523-4172
Mailing Address - Fax:
Practice Address - Street 1:501 5TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1907
Practice Address - Country:US
Practice Address - Phone:800-999-9709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085U0001X
WV335V00000X335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2804460Medicaid
WV3810010991Medicaid
WV3810010991Medicaid
OH5198018Medicare PIN
WV5198017Medicare PIN