Healthcare Provider Details

I. General information

NPI: 1902934110
Provider Name (Legal Business Name): COM-RAD MOBILE IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 BENWOOD TRL NE
CLEVELAND TN
37323-5096
US

IV. Provider business mailing address

339 BENWOOD TRL NE
CLEVELAND TN
37323-5096
US

V. Phone/Fax

Practice location:
  • Phone: 423-650-8353
  • Fax: 336-245-0649
Mailing address:
  • Phone: 423-650-8353
  • Fax: 336-245-0649

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. MARK MINTON
Title or Position: PRESIDENT
Credential:
Phone: 423-650-8353