=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851205389
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLOOM MOBILE ULTRASOUND LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2026
-----------------------------------------------------
Last Update Date | 10/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8535 N DIXIE DR STE D
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45414-2491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-572-5972
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1534 ASHWORTH DR
-----------------------------------------------------
City | VANDALIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45377-9503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-572-5972
-----------------------------------------------------
Fax | 937-518-7793
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HOLLY COBY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-572-5972
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335V00000X
-----------------------------------------------------
Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------