MEDICARE: INNOVATIVE MOBILE SERVICES 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	6638	CA

General Provider Information

NPI Number	:	1962650424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE MOBILE SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 2966
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64803-2966
Country	:	US
Telephone Number	:	417-626-9729
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 HEATHERVIEW DR
Second Line	:
City	:	OAK PARK
State	:	CA
Zip	:	91377-3914
Country	:	US
Telephone Number	:	818-879-8037
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL KELLEY
Credential	:
Telephone Number	:	417-626-9729

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	03/26/2009

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