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General NPI Number Information
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NPI Number | 1821670852
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Entity Type | Organization
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Legal Business Name | MOBILE TECH IMAGING LLC
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Dates
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Enumeration Date | 04/28/2021
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 201 STEMBRIDGE RD
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City | LAKE WALES
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State | FL
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Zip | 33898-9407
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Country | US
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Telephone | 863-412-4698
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Fax |
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Provider Business Mailing Address
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Address Line | 201 STEMBRIDGE RD
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City | LAKE WALES
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State | FL
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Zip | 33898-9407
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Country | US
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Telephone | 863-412-4698
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | PAMELA SUE WHITEHEAD
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Credential |
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Telephone | 863-412-4698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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