Healthcare Provider Details

I. General information

NPI: 1558743120
Provider Name (Legal Business Name): XRAYMOBILE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30466 SGT E I BOOTS THOMAS DR SUITE 206A
SPANISH FORT AL
36527-7630
US

IV. Provider business mailing address

30466 SGT E I BOOTS THOMAS DR SUITE 206A
SPANISH FORT AL
36527-7630
US

V. Phone/Fax

Practice location:
  • Phone: 251-626-4605
  • Fax: 251-517-1014
Mailing address:
  • Phone: 251-626-4605
  • Fax: 251-517-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN L SNYDER
Title or Position: OWNER/OPERATOR
Credential:
Phone: 985-290-9638