MEDICARE: MOBILE CARDIO VASCULAR 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	:	1700102456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE CARDIO VASCULAR INC

Provider Business Mailing Address
First Line	:	171 SCENIC RD
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1254
Country	:	US
Telephone Number	:	914-374-8731
Fax Number	:

Provider Business Practice Location Address
First Line	:	25710 UNION TPKE
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-1252
Country	:	US
Telephone Number	:	718-820-9365
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN WILSON
Credential	:
Telephone Number	:	914-374-8731

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	04/21/2010

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