Healthcare Provider Details

I. General information

NPI: 1003150327
Provider Name (Legal Business Name): MRS MOBILE RADIOLOGIC SERVICE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 E FRONT ST
DOVER OH
44622-1869
US

IV. Provider business mailing address

419 E FRONT ST
DOVER OH
44622-1869
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-1846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number79220
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberR2537365
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number79220
License Number StateOH

VIII. Authorized Official

Name: LYNDA SHALOSKY
Title or Position: VICE PRESIDENT
Credential:
Phone: 330-447-9159