Healthcare Provider Details

I. General information

NPI: 1467594614
Provider Name (Legal Business Name): MED-WAY MOBILE X RAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 MCHENRY CIRCLE
LIVINGSTON TN
38570
US

IV. Provider business mailing address

PO BOX 484
LIVINGSTON TN
38570
US

V. Phone/Fax

Practice location:
  • Phone: 931-319-0026
  • Fax: 931-823-0687
Mailing address:
  • Phone: 931-864-7795
  • Fax: 931-864-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number30082
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number5616
License Number StateTN

VIII. Authorized Official

Name: ARGYLE L GORE
Title or Position: CO OWNER
Credential:
Phone: 931-319-0026