MEDICARE: PROFESSIONAL XRAY MOBILITY 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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number	:	1851540173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL XRAY MOBILITY LLC

Provider Business Mailing Address
First Line	:	14700 S HARVEY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-7224
Country	:	US
Telephone Number	:	405-819-5308
Fax Number	:

Provider Business Practice Location Address
First Line	:	14700 S HARVEY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-7224
Country	:	US
Telephone Number	:	405-819-5308
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSEPH PAUL COODEY
Credential	:	RT (R)
Telephone Number	:	405-819-5308

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	09/10/2008

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