Healthcare Provider Details

I. General information

NPI: 1487624862
Provider Name (Legal Business Name): MOBILE DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 BROAD STREET
SUMTER SC
29150
US

IV. Provider business mailing address

PO BOX 369
SUMTER SC
29151
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-7246
  • Fax: 803-774-7250
Mailing address:
  • Phone: 803-436-5582
  • Fax: 803-436-0085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARSHALL A. WHITE
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 803-774-7246