MEDICARE: ULTRA MOBILE X-RAY 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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1174701387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRA MOBILE X-RAY INC

Provider Business Mailing Address
First Line	:	1001 N FEDERAL HWY
Second Line	:	SUITE 234
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-2408
Country	:	US
Telephone Number	:	954-404-7815
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 N FEDERAL HWY
Second Line	:	SUITE 234
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-2408
Country	:	US
Telephone Number	:	954-404-7815
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MUNEER HASAN
Credential	:
Telephone Number	:	773-544-1249

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	09/11/2013

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Directions to “ULTRA MOBILE X-RAY INC ” Practice Location

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