Healthcare Provider Details

I. General information

NPI: 1992769277
Provider Name (Legal Business Name): MOBILE IMAGING SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 HARVEST GLENN DR
DAVIS JUNCTION IL
61020-9797
US

IV. Provider business mailing address

149 HARVEST GLENN DR
DAVIS JUNCTION IL
61020-9797
US

V. Phone/Fax

Practice location:
  • Phone: 815-645-8985
  • Fax: 815-645-8985
Mailing address:
  • Phone: 815-645-8985
  • Fax: 815-645-8985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. ANDREA LYNN MILLER
Title or Position: PRESIDENT
Credential: RT (R)
Phone: 815-645-8985