MEDICARE: STAT MOBILE DIAGNOSTICS 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

General Provider Information

NPI Number	:	1750394094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAT MOBILE DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	18350 NW 2ND AVE
Second Line	:	SUITE 400
City	:	MIAMI
State	:	FL
Zip	:	33169-4519
Country	:	US
Telephone Number	:	305-621-7772
Fax Number	:	305-945-9856

Provider Business Practice Location Address
First Line	:	18350 NW 2ND AVE
Second Line	:	SUITE 400
City	:	MIAMI
State	:	FL
Zip	:	33169-4519
Country	:	US
Telephone Number	:	305-621-7772
Fax Number	:	305-945-9856

Authorized Official
Title or Position	:	COMPANY PRESIDENT
Name	:	JORGE L LOZANO
Credential	:	ARRT
Telephone Number	:	305-621-7772

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	08/22/2020

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