MEDICARE: MOBILE DIOGNOSTIC SOLUTIONS 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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1952584047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE DIOGNOSTIC SOLUTIONS LLC.

Provider Business Mailing Address
First Line	:	3695 WASHINGTON PARK BLVD
Second Line	:
City	:	NEWBURGH HEIGHTS
State	:	OH
Zip	:	44105-3177
Country	:	US
Telephone Number	:	440-781-7177
Fax Number	:

Provider Business Practice Location Address
First Line	:	3695 WASHINGTON PARK BLVD
Second Line	:
City	:	NEWBURGH HEIGHTS
State	:	OH
Zip	:	44105-3177
Country	:	US
Telephone Number	:	440-781-7177
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ALEX JUGUILON
Credential	:
Telephone Number	:	440-781-7077

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	12/11/2007

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