Provider Demographics
NPI:1770536260
Name:CAVALIER MOBILE XRAY CO
Entity type:Organization
Organization Name:CAVALIER MOBILE XRAY CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ETAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-337-1199
Mailing Address - Street 1:8235 CHRISTIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2910
Mailing Address - Country:US
Mailing Address - Phone:224-337-1197
Mailing Address - Fax:330-726-0270
Practice Address - Street 1:2089 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5240
Practice Address - Country:US
Practice Address - Phone:330-726-0202
Practice Address - Fax:330-726-0270
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALL-STAT PORTABLE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335V00000X
OH335V00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Single Specialty
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6803009000Medicaid
WV6803009000Medicaid
OH2287869Medicaid
OH=========OtherTAX ID NUMBER
WV6803009000Medicaid