Healthcare Provider Details

I. General information

NPI: 1396079760
Provider Name (Legal Business Name): MOBILE X-RAY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 EAGLECREST ST SUITE E
NIXA MO
65714-8458
US

IV. Provider business mailing address

3825 S CAMPBELL AVE PMB # 198
SPRINGFIELD MO
65807-5339
US

V. Phone/Fax

Practice location:
  • Phone: 417-863-9729
  • Fax: 417-863-0720
Mailing address:
  • Phone: 417-863-9729
  • Fax: 417-863-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number000040114
License Number StateMO

VIII. Authorized Official

Name: DR. JAMES PATRICK BERRIGAN
Title or Position: OWNER
Credential: M.D.
Phone: 913-558-9396