Provider Demographics
NPI:1316083595
Name:PHYSICIAN'S MOBILE X-RAY, INC.
Entity type:Organization
Organization Name:PHYSICIAN'S MOBILE X-RAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GELBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-561-4940
Mailing Address - Street 1:6310 ALLENTOWN BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2739
Mailing Address - Country:US
Mailing Address - Phone:717-561-4940
Mailing Address - Fax:717-561-4999
Practice Address - Street 1:945 E PARK DR
Practice Address - Street 2:STE 102
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2804
Practice Address - Country:US
Practice Address - Phone:717-561-4940
Practice Address - Fax:717-561-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1507996OtherGATEWAY PA MEDICAID
PA335685OtherADVANTRA
PA000000094397OtherUNISON HEALTH PLAN
PA000399807OtherHIGHMARK
PA1507996OtherGATEWAY MEDICARE ASSURED
PA441630015OtherUNITED HEALTHCARE RR MC
PA000138896OtherAPWU
PA000859039Medicaid
PA25-1352947OtherCONTINENTAL GENERAL INS
PA25-1352947OtherUNITED HEALTHCARE
PA441630015OtherUNITED HEALTHCARE RR MC
PA1507996OtherGATEWAY MEDICARE ASSURED
PA=========OtherAETNA
PA000138896OtherAPWU
PA000399807OtherHIGHMARK
PA25-1352947OtherUNITED HEALTHCARE
PA335685OtherADVANTRA
PA441630015OtherUNITED HEALTHCARE RR MC
PA1507996OtherGATEWAY MEDICARE ASSURED