Healthcare Provider Details

I. General information

NPI: 1396745071
Provider Name (Legal Business Name): MOBILE RADIOLOGY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 COUNTY ROAD 391
JONESBORO AR
72401-0619
US

IV. Provider business mailing address

556 COUNTY ROAD 391
JONESBORO AR
72401-0619
US

V. Phone/Fax

Practice location:
  • Phone: 870-926-1120
  • Fax: 870-586-5702
Mailing address:
  • Phone: 870-926-1120
  • Fax: 870-586-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number260009834
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number19816
License Number StateAR

VIII. Authorized Official

Name: MRS. SUZANNE MARTIN
Title or Position: OWNER
Credential:
Phone: 870-926-1120