Healthcare Provider Details

I. General information

NPI: 1083686240
Provider Name (Legal Business Name): MOBILE RAD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E WALNUT ST SUITE 621A
PERKASIE PA
18944-5444
US

IV. Provider business mailing address

3 CABOT PL UNIT 9
STOUGHTON MA
02072-4612
US

V. Phone/Fax

Practice location:
  • Phone: 215-453-7360
  • Fax: 215-453-7362
Mailing address:
  • Phone: 800-636-9729
  • Fax: 781-341-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLAN E SMITH
Title or Position: PRESIDENT
Credential:
Phone: 800-636-9729