Healthcare Provider Details

I. General information

NPI: 1376749812
Provider Name (Legal Business Name): MOBILE X-RAY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 N 20TH ST
OZARK MO
65721-5925
US

IV. Provider business mailing address

3050 N 20TH ST
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 Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

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