Healthcare Provider Details

I. General information

NPI: 1215239116
Provider Name (Legal Business Name): MOBILE IMAGING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2010
Last Update Date: 11/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 CEDAR DR
CASSVILLE MO
65625-1913
US

IV. Provider business mailing address

1535 CEDAR DR
CASSVILLE MO
65625-1913
US

V. Phone/Fax

Practice location:
  • Phone: 417-846-0125
  • Fax:
Mailing address:
  • Phone: 417-846-0125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CONNIE LYNN BUTLER
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 417-846-0125