MEDICARE: U.S. MOBILE DIAGNOSTIC, 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	213E00000X	Podiatrist	HCC6512	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HCC6512	OTHER	FL	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1093769531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	U.S. MOBILE DIAGNOSTIC, LLC

Provider Business Mailing Address
First Line	:	3907 N FEDERAL HWY
Second Line	:	SUITE 112
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-6042
Country	:	US
Telephone Number	:	954-461-8624
Fax Number	:	954-596-8132

Provider Business Practice Location Address
First Line	:	3907 N FEDERAL HWY
Second Line	:	SUITE 112
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-6042
Country	:	US
Telephone Number	:	954-461-8624
Fax Number	:	954-596-8132

Authorized Official
Title or Position	:	CO-OWNER/MEDICAL DIRECTOR
Name	:	DR. JEFFREY JOHN TRANTALIS
Credential	:	D.P.M.
Telephone Number	:	954-461-8624

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	10/15/2007

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