Healthcare Provider Details

I. General information

NPI: 1386726438
Provider Name (Legal Business Name): E.T. MOBILE IMAGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 FARM ROAD 2297
SULPHUR SPRINGS TX
75482-4719
US

IV. Provider business mailing address

472 FARM ROAD 2297
SULPHUR SPRINGS TX
75482-4719
US

V. Phone/Fax

Practice location:
  • Phone: 903-885-3200
  • Fax: 903-439-0462
Mailing address:
  • Phone: 903-885-3200
  • Fax: 903-439-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberR22095
License Number StateTX

VIII. Authorized Official

Name: MR. ROY WAYNE MCGAHEE
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 903-885-3200