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General NPI Number Information
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NPI Number | 1831508233
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Entity Type | Organization
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Legal Business Name | PREMIUM MOBILE X-RAYS LLC
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 608 WALNUT BEND DR
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City | MANSFIELD
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State | TX
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Zip | 76063-5850
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Country | US
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Telephone | 682-401-0609
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Fax | 866-301-2005
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Provider Business Mailing Address
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Address Line | 608 WALNUT BEND DR
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City | MANSFIELD
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State | TX
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Zip | 76063-5850
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Country | US
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Telephone | 682-401-0609
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Fax | 866-301-2005
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Authorized Official
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Title or Position | FOUNDER
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Name | MR. STEVEN BUTLER
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Credential |
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Telephone | 972-965-1536
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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 | 802031012
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License Number State | TX
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