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General NPI Number Information
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NPI Number | 1609272236
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Entity Type | Organization
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Legal Business Name | EZ MOBILE DIAGNOSTIC SERVICES MANAGEMENT INC
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 3401 CUSTER RD STE 170
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City | PLANO
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State | TX
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Zip | 75023-7599
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Country | US
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Telephone | 972-975-7977
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Fax | 214-299-9329
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Provider Business Mailing Address
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Address Line | 3401 CUSTER RD STE 170
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City | PLANO
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State | TX
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Zip | 75023-7599
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Country | US
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Telephone | 972-975-7977
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Fax | 214-299-9329
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROMA AGASYAN
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Credential |
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Telephone | 972-975-7977
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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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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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