Healthcare Provider Details

I. General information

NPI: 1851205389
Provider Name (Legal Business Name): BLOOM MOBILE ULTRASOUND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8535 N DIXIE DR STE D
DAYTON OH
45414-2491
US

IV. Provider business mailing address

1534 ASHWORTH DR
VANDALIA OH
45377-9503
US

V. Phone/Fax

Practice location:
  • Phone: 937-572-5972
  • Fax:
Mailing address:
  • Phone: 937-572-5972
  • Fax: 937-518-7793

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 StateNULL

VIII. Authorized Official

Name: HOLLY COBY
Title or Position: OWNER
Credential:
Phone: 937-572-5972