Healthcare Provider Details

I. General information

NPI: 1992856488
Provider Name (Legal Business Name): MOBILE X-RAY SERVICES OF SHREVEPORT BOSSIER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 ALBEMARLE DR STE 202
SHREVEPORT LA
71106-5946
US

IV. Provider business mailing address

670 ALBEMARLE DR STE 202
SHREVEPORT LA
71106-5946
US

V. Phone/Fax

Practice location:
  • Phone: 318-687-6861
  • Fax: 318-687-6768
Mailing address:
  • Phone: 318-687-6861
  • Fax: 318-687-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MEAGAN MOTON
Title or Position: PRESIDENT
Credential:
Phone: 318-687-6861