Provider Demographics
NPI:1831542935
Name:DELTA MOBILE RADIOLOGY, LLC
Entity type:Organization
Organization Name:DELTA MOBILE RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENIGNO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-262-2220
Mailing Address - Street 1:17617 CAMPANA LN W
Mailing Address - Street 2:
Mailing Address - City:EDCOUCH
Mailing Address - State:TX
Mailing Address - Zip Code:78538-1701
Mailing Address - Country:US
Mailing Address - Phone:956-262-2220
Mailing Address - Fax:956-262-2221
Practice Address - Street 1:17617 CAMPANA LN W
Practice Address - Street 2:
Practice Address - City:EDCOUCH
Practice Address - State:TX
Practice Address - Zip Code:78538-1701
Practice Address - Country:US
Practice Address - Phone:956-262-2220
Practice Address - Fax:956-262-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR41277335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier