MEDICARE: MOBILE MEDICAL DIAGNOSTIC SERVICES

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	261QR0208X	Mobile Radiology Clinic/Center	00419	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	630001464	OTHER	IA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45171	OTHER	IA	WELLMARK BC/BS OF IOWA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306845094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE MEDICAL DIAGNOSTIC SERVICES

Provider Business Mailing Address
First Line	:	6223 HIGHWAY 63
Second Line	:
City	:	OTTUMWA
State	:	IA
Zip	:	52501-8175
Country	:	US
Telephone Number	:	641-777-1363
Fax Number	:	641-682-6836

Provider Business Practice Location Address
First Line	:	6223 HIGHWAY 63
Second Line	:
City	:	OTTUMWA
State	:	IA
Zip	:	52501-8175
Country	:	US
Telephone Number	:	641-777-1363
Fax Number	:	641-682-6836

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DARIN LEE DELKER
Credential	:
Telephone Number	:	641-777-1363

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	04/08/2013

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Directions to “MOBILE MEDICAL DIAGNOSTIC SERVICES ” Practice Location

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