Healthcare Provider Details

I. General information

NPI: 1851540173
Provider Name (Legal Business Name): PROFESSIONAL XRAY MOBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 S HARVEY AVE
OKLAHOMA CITY OK
73170-7224
US

IV. Provider business mailing address

14700 S HARVEY AVE
OKLAHOMA CITY OK
73170-7224
US

V. Phone/Fax

Practice location:
  • Phone: 405-819-5308
  • Fax:
Mailing address:
  • Phone: 405-819-5308
  • Fax:

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 State

VIII. Authorized Official

Name: MR. JOSEPH PAUL COODEY
Title or Position: OWNER
Credential: RT (R)
Phone: 405-819-5308