Healthcare Provider Details

I. General information

NPI: 1558655548
Provider Name (Legal Business Name): MOBILE MRI MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 HATCHER LN
COLUMBIA TN
38401-3535
US

IV. Provider business mailing address

PO BOX 805
COLUMBIA TN
38402-0805
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-6596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MRS. KATHERINE BOND
Title or Position: BUSINESS MANAGER
Credential:
Phone: 931-388-6596