Healthcare Provider Details

I. General information

NPI: 1639566011
Provider Name (Legal Business Name): MOBILE X-RAY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 N. 20TH STREET
OZARK MO
65721-5925
US

IV. Provider business mailing address

3050 N. 20TH STREET
OZARK MO
65721-5925
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 Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: EARL MAES
Title or Position: PRESIDENT
Credential: M.D,
Phone: 417-863-9729