Healthcare Provider Details

I. General information

NPI: 1215004007
Provider Name (Legal Business Name): RAD MOBILE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CONSTITUTION AVE NE
WASHINGTON DC
20002-6058
US

IV. Provider business mailing address

PO BOX 92475
WASHINGTON DC
20090-2475
US

V. Phone/Fax

Practice location:
  • Phone: 202-270-7829
  • Fax:
Mailing address:
  • Phone: 202-270-7829
  • 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 Number299345
License Number StateDC

VIII. Authorized Official

Name: MR. WARREN OLETHUS DAWSON
Title or Position: CEO
Credential: ARRT
Phone: 202-270-7829