Healthcare Provider Details

I. General information

NPI: 1417002692
Provider Name (Legal Business Name): CAVALIER MOBILE XRAY CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 E WESTERN RESERVE RD UNIT 10D
YOUNGSTOWN OH
44514-3354
US

IV. Provider business mailing address

8235 CHRISTIANA AVE
SKOKIE IL
60076-2910
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-0202
  • Fax: 330-726-0270
Mailing address:
  • Phone: 224-337-1197
  • Fax: 224-337-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License NumberR2377049
License Number StateOH

VIII. Authorized Official

Name: ETAI SOOLIMAN
Title or Position: CEO
Credential:
Phone: 224-337-1199