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General NPI Number Information
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NPI Number | 1053302042
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Entity Type | Organization
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Legal Business Name | MOBILE MEDICAL RADIOGRAPHY AND EKG INC
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 109 RHODE ISLAND RD CLEAR POND OFFICES
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City | LAKEVILLE
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State | MA
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Zip | 02347-1370
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Country | US
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Telephone | 508-923-6171
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Fax | 508-923-6248
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Provider Business Mailing Address
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Address Line | 109 RHODE ISLAND RD CLEAR POND OFFICES
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City | LAKEVILLE
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State | MA
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Zip | 02347-1370
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Country | US
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Telephone | 508-923-6171
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Fax | 508-923-6248
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Authorized Official
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Title or Position | VP OF ADMINISTRATIVE SERVICES
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Name | MRS. MINDA DE MEDEIROS
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Credential | MHA
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Telephone | 508-923-6171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | 08305
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License Number State | MA
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