MEDICARE: MOBILE RADIOLOGY & EKG OF NEVADA, 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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number	:	1609853555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE RADIOLOGY & EKG OF NEVADA, INC.

Provider Business Mailing Address
First Line	:	PO BOX 17488
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33762-0488
Country	:	US
Telephone Number	:	727-443-0389
Fax Number	:	727-442-7851

Provider Business Practice Location Address
First Line	:	1050 E FLAMINGO RD
Second Line	:	SUITE N-138 BOX 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7427
Country	:	US
Telephone Number	:	702-258-7993
Fax Number	:	702-319-5217

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. RANDALL W CARTWRIGHT
Credential	:
Telephone Number	:	727-443-0389

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	08/22/2020

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