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General NPI Number Information
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NPI Number | 1417279258
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Entity Type | Organization
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Legal Business Name | 3D MOBILE IMAGING LLC
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Dates
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Enumeration Date | 02/21/2010
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Last Update Date | 02/21/2010
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Provider Practice Location Address
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Address Line | 2501 E 1704TH RD
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City | OTTAWA
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State | IL
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Zip | 61350-9331
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Country | US
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Telephone | 309-751-7552
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 E 1704TH RD
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City | OTTAWA
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State | IL
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Zip | 61350-9331
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Country | US
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Telephone | 309-751-7552
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. DEBORAH KATHERINE VESSELL
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Credential |
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Telephone | 309-751-7552
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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 | 9259150
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License Number State | IL
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