Healthcare Provider Details

I. General information

NPI: 1306845094
Provider Name (Legal Business Name): MOBILE MEDICAL DIAGNOSTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6223 HIGHWAY 63
OTTUMWA IA
52501-8175
US

IV. Provider business mailing address

6223 HIGHWAY 63
OTTUMWA IA
52501-8175
US

V. Phone/Fax

Practice location:
  • Phone: 641-777-1363
  • Fax: 641-682-6836
Mailing address:
  • Phone: 641-777-1363
  • Fax: 641-682-6836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number00419
License Number StateIA

VIII. Authorized Official

Name: MR. DARIN LEE DELKER
Title or Position: OWNER
Credential:
Phone: 641-777-1363