Healthcare Provider Details

I. General information

NPI: 1578691689
Provider Name (Legal Business Name): MOBILE X-RAY SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 SCHOOL AVE
WALLA WALLA WA
99362-1497
US

IV. Provider business mailing address

1014 SCHOOL AVE
WALLA WALLA WA
99362-1497
US

V. Phone/Fax

Practice location:
  • Phone: 509-527-1274
  • Fax:
Mailing address:
  • Phone: 509-527-1274
  • Fax: 509-522-4938

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: MRS. LAURA J SCHMIDT
Title or Position: OWNER
Credential:
Phone: 509-527-1274