Healthcare Provider Details

I. General information

NPI: 1609980184
Provider Name (Legal Business Name): ELITE MOBILE RADIOLOGY & EKG SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 EL MONTE CT
RENO NV
89521-4117
US

IV. Provider business mailing address

PO BOX 50538
SPARKS NV
89435-0538
US

V. Phone/Fax

Practice location:
  • Phone: 775-690-9729
  • Fax: 775-851-2797
Mailing address:
  • Phone: 775-690-9729
  • Fax: 775-851-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number167099
License Number StateNV

VIII. Authorized Official

Name: MR. TIMOTHY R. TROKE
Title or Position: DIRECTOR
Credential: X-RAY TECH
Phone: 775-690-9729