Provider Demographics
NPI:1750394094
Name:STAT MOBILE DIAGNOSTICS INC
Entity type:Organization
Organization Name:STAT MOBILE DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT
Authorized Official - Phone:305-621-7772
Mailing Address - Street 1:18350 NW 2ND AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4519
Mailing Address - Country:US
Mailing Address - Phone:305-621-7772
Mailing Address - Fax:305-945-9856
Practice Address - Street 1:18350 NW 2ND AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4519
Practice Address - Country:US
Practice Address - Phone:305-621-7772
Practice Address - Fax:305-945-9856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLW9906Medicare ID - Type Unspecified
FLE2241Medicare ID - Type Unspecified