Provider Demographics
NPI:1104923614
Name:DIAGNOSTIC MOBILE X-RAY INC
Entity type:Organization
Organization Name:DIAGNOSTIC MOBILE X-RAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONELL
Authorized Official - Middle Name:MELAINE
Authorized Official - Last Name:GATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-639-9729
Mailing Address - Street 1:28100 CHALLENGER BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33982
Mailing Address - Country:US
Mailing Address - Phone:941-639-9729
Mailing Address - Fax:941-639-5100
Practice Address - Street 1:28100 CHALLENGER BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33982
Practice Address - Country:US
Practice Address - Phone:941-639-9729
Practice Address - Fax:941-639-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLW9936Medicare ID - Type Unspecified