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General NPI Number Information
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NPI Number | 1831588953
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Entity Type | Organization
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Legal Business Name | STAR MOBILE IMAGING
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 310 SAN MATEO CT
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City | IRVING
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State | TX
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Zip | 75062-4509
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Country | US
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Telephone | 228-209-3371
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Fax |
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Provider Business Mailing Address
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Address Line | 310 SAN MATEO CT
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City | IRVING
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State | TX
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Zip | 75062-4509
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Country | US
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Telephone | 214-680-5970
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRANDON HOLBERT
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Credential | RVT
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Telephone | 214-680-5970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | 15327
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License Number State | TX
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