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General NPI Number Information
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NPI Number | 1679844963
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Entity Type | Organization
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Legal Business Name | MICHIGAN MOBILE IMAGING, LLC
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Dates
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Enumeration Date | 01/19/2012
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 15500 LUNDY PKWY ATTN: TAMMY FLYNN (N201)
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City | DEARBORN
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State | MI
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Zip | 48126-2778
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Country | US
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Telephone | 313-586-5669
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Fax | 313-791-4563
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Provider Business Mailing Address
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Address Line | 15500 LUNDY PKWY ATTN: TAMMY FLYNN (N201)
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City | DEARBORN
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State | MI
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Zip | 48126-2778
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Country | US
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Telephone | 313-586-5669
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Fax | 313-791-4563
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Authorized Official
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Title or Position | CORPORATE DIRECTOR
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Name | MR. TIMOTHY VARGAS
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Credential |
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Telephone | 313-593-7623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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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 | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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