MEDICARE: MOBILE IMAGING OF ST LUCIE COUNTY 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	JR28288000	FL

General Provider Information

NPI Number	:	1750382198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE IMAGING OF ST LUCIE COUNTY INC

Provider Business Mailing Address
First Line	:	120 66TH AVE SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-9706
Country	:	US
Telephone Number	:	772-569-9729
Fax Number	:	772-569-2769

Provider Business Practice Location Address
First Line	:	120 66TH AVE SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-9706
Country	:	US
Telephone Number	:	772-569-9729
Fax Number	:	772-569-2769

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ROSANNA CRAWFORD
Credential	:	RN
Telephone Number	:	772-569-9729

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	10/01/2010

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