MEDICARE: MOBILE DIAGNOSTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1073769451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	8112 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-3736
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8112 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-3736
Country	:	US
Telephone Number	:	714-926-0273
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. KAVAN P SINGH
Credential	:
Telephone Number	:	714-926-0273

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	08/18/2008

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