1922241835 NPI number — MOBILERADIOLOGY.ORG LLC

Table of content: (NPI 1922241835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922241835 NPI number — MOBILERADIOLOGY.ORG LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILERADIOLOGY.ORG LLC
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:
6
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:
1922241835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5275 NAIMAN RD
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
SOLON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44139-1033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-645-7822
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13645 MCKINLEY HWY
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
MISHAWAKA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46545-7492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-274-2300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BARRY
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
440-645-7822

Provider Taxonomy Codes

  • Taxonomy code: 335V00000X , with the licence number:  XT010239 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200943790 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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