MEDICARE: MOBLIE DIAGNOSTIC IMAGING INC.

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	HCC6340	FL

General Provider Information

NPI Number	:	1275532632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBLIE DIAGNOSTIC IMAGING INC.

Provider Business Mailing Address
First Line	:	PO BOX 550819
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33355-0819
Country	:	US
Telephone Number	:	954-452-5638
Fax Number	:	954-452-5639

Provider Business Practice Location Address
First Line	:	12555 ORANGE DR
Second Line	:	SUITE 101
City	:	DAVIE
State	:	FL
Zip	:	33330-4304
Country	:	US
Telephone Number	:	954-452-5638
Fax Number	:	954-452-5639

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. BRAD KANTOR
Credential	:
Telephone Number	:	954-452-5638

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	05/06/2016

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