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General NPI Number Information
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NPI Number | 1528781184
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Entity Type | Organization
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Legal Business Name | MANTRO MOBILE IMAGING, LLC
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 2601 N STOCKTON HILL RD STE H-12
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City | KINGMAN
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State | AZ
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Zip | 86401-4191
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Country | US
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Telephone | 702-896-0473
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Fax |
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Provider Business Mailing Address
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Address Line | 8778 S MARYLAND PKWY STE 105
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City | LAS VEGAS
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State | NV
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Zip | 89123-6705
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Country | US
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Telephone | 434-989-8851
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | JOHN MISSIG
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Credential | R.N.
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Telephone | 434-989-8851
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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 |
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License Number State |
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