Healthcare Provider Details

I. General information

NPI: 1194000943
Provider Name (Legal Business Name): MANTRO MOBILE IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 01/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8778 S MARYLAND PKWY SUITE 105
LAS VEGAS NV
89123-6704
US

IV. Provider business mailing address

8778 S MARYLAND PKWY SUITE 105
LAS VEGAS NV
89123-6704
US

V. Phone/Fax

Practice location:
  • Phone: 702-896-0473
  • Fax: 702-586-0528
Mailing address:
  • Phone: 702-896-0473
  • Fax: 702-586-0528

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: MR. KENNETH ROGER CHAPMAN JR.
Title or Position: MANAGING MEMBER
Credential: RN
Phone: 702-896-0473