=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538491113
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOST PINES MOBILE IMAGING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2010
-----------------------------------------------------
Last Update Date | 01/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4337 LINDBERGH DR
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75001-4539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-224-1329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2101 SHANNON OXMOOR RD # 67
-----------------------------------------------------
City | SHANNON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35142-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-212-4243
-----------------------------------------------------
Fax | 205-847-5262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SAI K RAVI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-841-1113
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------