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General NPI Number Information
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NPI Number | 1891717799
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Entity Type | Organization
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Legal Business Name | WICHITA AREA MOBILE SERVICE
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 2113 KELL BLVD STE E
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City | WICHITA FALLS
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State | TX
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Zip | 76308-1256
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Country | US
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Telephone | 940-761-2882
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Fax |
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Provider Business Mailing Address
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Address Line | 2113 KELL BLVD STE E
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City | WICHITA FALLS
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State | TX
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Zip | 76308-1256
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Country | US
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Telephone | 940-761-2882
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES E. FANCHER
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Credential |
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Telephone | 940-761-2882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | 45-X0009901
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License Number State | TX
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