Healthcare Provider Details

I. General information

NPI: 1467407478
Provider Name (Legal Business Name): MOBILE DEXA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8996 TERWILLIGERS VW
CINCINNATI OH
45249-2727
US

IV. Provider business mailing address

8996 TERWILLIGERS VW
CINCINNATI OH
45249-2727
US

V. Phone/Fax

Practice location:
  • Phone: 513-382-9328
  • Fax:
Mailing address:
  • Phone: 513-382-9328
  • Fax:

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: VASANT PRABHU
Title or Position: PRESIDENT
Credential:
Phone: 513-382-9328