1891886354 NPI number — MOBILE X-RAY SERVICES INC

Table of content: (NPI 1891886354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891886354 NPI number — MOBILE X-RAY SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE X-RAY SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891886354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1209 MOCKINGBIRD LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUTHRIE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73044-2070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-282-4647
Provider Business Mailing Address Fax Number:
405-282-1758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 N CLASSEN BLVD
Provider Second Line Business Practice Location Address:
SUITE 123
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73114-2128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-826-3370
Provider Business Practice Location Address Fax Number:
405-470-1340
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEHN
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
405-282-4647

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200004490A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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