Healthcare Provider Details

I. General information

NPI: 1043390941
Provider Name (Legal Business Name): MOBILE MEDICAL DIAGNOSTIC SERVICES OF OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 SANDUSKY ST
ASHLAND OH
44805-1143
US

IV. Provider business mailing address

821 SANDUSKY ST
ASHLAND OH
44805-1143
US

V. Phone/Fax

Practice location:
  • Phone: 419-289-8085
  • Fax: 419-289-8584
Mailing address:
  • Phone: 419-289-8085
  • Fax: 419-289-8584

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 StateOH

VIII. Authorized Official

Name: MR. DAVID GALE HOUSEWRIGHT
Title or Position: OWNER
Credential:
Phone: 419-289-8085