Healthcare Provider Details

I. General information

NPI: 1679722615
Provider Name (Legal Business Name): SIMPLY MOBILE X-RAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 W 12TH LN
YUMA AZ
85364-9107
US

IV. Provider business mailing address

3661 W 12TH LN
YUMA AZ
85364-9107
US

V. Phone/Fax

Practice location:
  • Phone: 928-261-6379
  • Fax: 928-276-4834
Mailing address:
  • Phone: 928-261-6379
  • Fax: 928-276-4834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberRHT 92930
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberCRT-14994
License Number StateAZ

VIII. Authorized Official

Name: MR. STEVEN Y CHANG
Title or Position: PRESIDENT
Credential: R.T.
Phone: 928-261-6379