MEDICARE: HEALTHY IMAGES MOBILE SCANNING, 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	293D00000X	Physiological Laboratory	18384	TX

General Provider Information

NPI Number	:	1952542821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY IMAGES MOBILE SCANNING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1646
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640-1646
Country	:	US
Telephone Number	:	888-750-1714
Fax Number	:	254-399-0702

Provider Business Practice Location Address
First Line	:	1760 FM 967
Second Line	:	SUITE 200
City	:	BUDA
State	:	TX
Zip	:	78610-2884
Country	:	US
Telephone Number	:	888-750-1714
Fax Number	:	254-399-0702

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RICHARD J NIEMEYER
Credential	:
Telephone Number	:	512-992-7713

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	03/23/2009

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