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General NPI Number Information
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NPI Number | 1619626249
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Entity Type | Organization
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Legal Business Name | MOBILE XRAY SERVICE LLC
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Dates
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Enumeration Date | 03/21/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 10 NOB HILL DR
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City | SAINT LOUIS
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State | MO
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Zip | 63138-1458
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Country | US
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Telephone | 314-584-9330
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Fax |
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Provider Business Mailing Address
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Address Line | 10 NOB HILL DR
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City | SAINT LOUIS
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State | MO
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Zip | 63138-1458
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Country | US
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Telephone | 314-584-9330
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Fax |
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Authorized Official
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Title or Position | RADIOGAPHER
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Name | LAMARE J BUTLER
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Credential | ARRT (R) (CT)(R)
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Telephone | 314-584-9330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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