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General NPI Number Information
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NPI Number | 1710219167
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Entity Type | Organization
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Legal Business Name | MOBILE IMAGING OF ST LUCIE COUNTY INC
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 120 66TH AVE SW
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City | VERO BEACH
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State | FL
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Zip | 32968-9706
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Country | US
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Telephone | 772-569-9729
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Fax | 772-569-2769
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Provider Business Mailing Address
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Address Line | 120 66TH AVE SW
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City | VERO BEACH
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State | FL
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Zip | 32968-9706
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Country | US
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Telephone | 772-569-9729
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Fax | 772-569-2769
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Authorized Official
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Title or Position | OWNER
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Name | ROSANNA CRAWFORD
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Credential |
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Telephone | 772-569-9729
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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 | HCC5034
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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