MEDICARE: DR MOBILE IMAGING, 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	:	1851949291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR MOBILE IMAGING, LLC

Provider Business Mailing Address
First Line	:	23 WESTHAVEN PL
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-1758
Country	:	US
Telephone Number	:	731-803-1078
Fax Number	:	731-435-3385

Provider Business Practice Location Address
First Line	:	23 WESTHAVEN PL
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-1758
Country	:	US
Telephone Number	:	731-803-1078
Fax Number	:	731-435-3385

Authorized Official
Title or Position	:	OWNER
Name	:	DAVIN RAY MODISETTE
Credential	:
Telephone Number	:	318-475-0690

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	12/28/2022

Similar Medicare Providers

1356721245 — DAVIN RAY MODISETTE
Practice Location Address:

23 WESTHAVEN PL
JACKSON, TN
38305-1758

Practice Phone: 318-475-0690
Practice Fax: 731-435-3385

1811852536 — SARAH GANDEE
Practice Location Address:

353 E MAIN ST
JACKSON, OH
45640-1758

Practice Phone: 740-286-6401
Practice Fax:

1013921774 — DR. JAMES AARON ROYLE JR. D.C.
Practice Location Address:

255 S NEW PROSPECT RD
JACKSON, NJ
08527-1758

Practice Phone: 732-367-1099
Practice Fax: 732-367-1909

1467555185 — OHIO CVS STORES LLC
Practice Location Address:

353 E MAIN ST
JACKSON, OH
45640-1758

Practice Phone: 740-286-6401
Practice Fax:

1902400120 — LESLIE LYNN LEACH
Practice Location Address:

353 E MAIN ST
JACKSON, OH
45640-1758

Practice Phone: 740-286-6401
Practice Fax: 740-286-4069

1861097834 — DONALD ARTHUR BROWN
Practice Location Address:

353 E MAIN ST
JACKSON, OH
45640-1758

Practice Phone: 740-286-3562
Practice Fax:

Directions to “DR MOBILE IMAGING, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.