MEDICARE: MOBILE MEDICAL RADIOGRAPHY AND EKG INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	08305	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	209805	OTHER	ME	MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053302042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE MEDICAL RADIOGRAPHY AND EKG INC

Provider Business Mailing Address
First Line	:	109 RHODE ISLAND RD
Second Line	:	CLEAR POND OFFICES
City	:	LAKEVILLE
State	:	MA
Zip	:	02347-1370
Country	:	US
Telephone Number	:	508-923-6171
Fax Number	:	508-923-6248

Provider Business Practice Location Address
First Line	:	109 RHODE ISLAND RD
Second Line	:	CLEAR POND OFFICES
City	:	LAKEVILLE
State	:	MA
Zip	:	02347-1370
Country	:	US
Telephone Number	:	508-923-6171
Fax Number	:	508-923-6248

Authorized Official
Title or Position	:	VP OF ADMINISTRATIVE SERVICES
Name	:	MRS. MINDA DE MEDEIROS
Credential	:	MHA
Telephone Number	:	508-923-6171

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	12/13/2007

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Directions to “MOBILE MEDICAL RADIOGRAPHY AND EKG INC ” Practice Location

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