Provider Demographics
NPI:1386726438
Name:E.T. MOBILE IMAGING, INC.
Entity type:Organization
Organization Name:E.T. MOBILE IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MCGAHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-885-3200
Mailing Address - Street 1:472 FARM ROAD 2297
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-4719
Mailing Address - Country:US
Mailing Address - Phone:903-885-3200
Mailing Address - Fax:903-439-0462
Practice Address - Street 1:472 FARM ROAD 2297
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4719
Practice Address - Country:US
Practice Address - Phone:903-885-3200
Practice Address - Fax:903-439-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR22095247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086112201Medicaid
TX086112201Medicaid
TX459876Medicare ID - Type Unspecified