Provider Demographics
NPI:1386895084
Name:MOBILE DIAGNOSTIC SERVICES, INC
Entity type:Organization
Organization Name:MOBILE DIAGNOSTIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-208-0899
Mailing Address - Street 1:7930 N UNIVERSITY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1802
Mailing Address - Country:US
Mailing Address - Phone:309-689-0243
Mailing Address - Fax:
Practice Address - Street 1:7930 N UNIVERSITY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1802
Practice Address - Country:US
Practice Address - Phone:309-689-0243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier