MEDICARE: AMERICAN MOBILE X-RAY, 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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1689000580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN MOBILE X-RAY, LLC

Provider Business Mailing Address
First Line	:	6802 MENZ LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45233-4311
Country	:	US
Telephone Number	:	513-741-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6802 MENZ LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45233-4311
Country	:	US
Telephone Number	:	513-741-1600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMIE BETTIS
Credential	:
Telephone Number	:	513-741-1600

Provider Enumeration Date	:	09/24/2013
Last Update Date	:	09/24/2013

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