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General NPI Number Information
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NPI Number | 1275532632
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Entity Type | Organization
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Legal Business Name | MOBLIE DIAGNOSTIC IMAGING INC.
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 05/06/2016
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Provider Practice Location Address
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Address Line | 12555 ORANGE DR SUITE 101
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City | DAVIE
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State | FL
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Zip | 33330-4304
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Country | US
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Telephone | 954-452-5638
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Fax | 954-452-5639
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Provider Business Mailing Address
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Address Line | PO BOX 550819
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City | FT LAUDERDALE
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State | FL
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Zip | 33355-0819
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Country | US
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Telephone | 954-452-5638
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Fax | 954-452-5639
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. BRAD KANTOR
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Credential |
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Telephone | 954-452-5638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | HCC6340
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License Number State | FL
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