Healthcare Provider Details

I. General information

NPI: 1760469795
Provider Name (Legal Business Name): MOBILE RADIOLOGY & EKG SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13773 ICOT BLVD SUITE 502
CLEARWATER FL
33760-3711
US

IV. Provider business mailing address

PO BOX 17159
CLEARWATER FL
33762-0159
US

V. Phone/Fax

Practice location:
  • Phone: 727-443-0389
  • Fax: 727-442-7851
Mailing address:
  • Phone: 727-449-0389
  • Fax: 727-442-7851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberHCC6550
License Number StateFL

VIII. Authorized Official

Name: MR. RANDALL W CARTWRIGHT
Title or Position: PRESIDENT/CEO
Credential:
Phone: 727-443-0389