=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295150092
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUALITY MOBILE IMAGING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2014
-----------------------------------------------------
Last Update Date | 03/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 5TH AVE SUITE 2
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25701-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-523-4172
-----------------------------------------------------
Fax | 304-523-8951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 5TH AVE SUITE 2
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25701-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-523-4172
-----------------------------------------------------
Fax | 304-523-8951
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | KAREN L ALLEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-523-4172
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335V00000X
-----------------------------------------------------
Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------