Provider Demographics
NPI:1780091140
Name:MBSS MOBILE, INC.
Entity type:Organization
Organization Name:MBSS MOBILE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIRWAJID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-613-9590
Mailing Address - Street 1:1919 S HIGHLAND AVE
Mailing Address - Street 2:BLDG 'C' SUITE 100
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1919 S HIGHLAND AVE
Practice Address - Street 2:BLDG 'C' SUITE 100
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6153
Practice Address - Country:US
Practice Address - Phone:630-613-9590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile