Healthcare Provider Details

I. General information

NPI: 1205840063
Provider Name (Legal Business Name): MOBILE DIAGNOSTIC IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SPRINGDALE AVE SUITE 3
WINTERSVILLE OH
43953-4133
US

IV. Provider business mailing address

120 SPRINGDALE AVE SUITE 3
WINTERSVILLE OH
43953-4133
US

V. Phone/Fax

Practice location:
  • Phone: 740-266-4908
  • Fax: 740-264-4376
Mailing address:
  • Phone: 740-266-4908
  • Fax: 740-264-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberPENDING
License Number StateOH

VIII. Authorized Official

Name: G SHANE WEES
Title or Position: OWNER
Credential:
Phone: 740-266-4908