Healthcare Provider Details

I. General information

NPI: 1891972147
Provider Name (Legal Business Name): DIRECT MOBILE IMAGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 DECATUR ST
ALVORD TX
76225-5085
US

IV. Provider business mailing address

702 DECATUR ST
ALVORD TX
76225-5085
US

V. Phone/Fax

Practice location:
  • Phone: 940-427-2247
  • Fax: 940-427-2749
Mailing address:
  • Phone: 940-577-2230
  • Fax: 940-427-2749

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. BENJAMIN L HURST
Title or Position: MANAGING MEMBER
Credential: RDCS, RVT, EMTP
Phone: 940-427-2247