Healthcare Provider Details

I. General information

NPI: 1811403637
Provider Name (Legal Business Name): MED MOBILE DIGITAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 12/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S JACKSON STE 321
MAGNOLIA AR
71753-3540
US

IV. Provider business mailing address

9376 MANSFIELD RD
SHREVEPORT LA
71118-3181
US

V. Phone/Fax

Practice location:
  • Phone: 318-347-6872
  • Fax: 318-347-6872
Mailing address:
  • Phone: 318-687-6861
  • Fax:

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 StateAR

VIII. Authorized Official

Name: MEAGAN MOTON
Title or Position: OWNER
Credential:
Phone: 318-687-6861