Provider Demographics
NPI:1427056522
Name:KOSMA MOBILE X-RAY CO., INC.
Entity type:Organization
Organization Name:KOSMA MOBILE X-RAY CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOSMA
Authorized Official - Suffix:
Authorized Official - Credentials:RTR
Authorized Official - Phone:417-863-9729
Mailing Address - Street 1:1678 S FARM ROAD 133
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1013
Mailing Address - Country:US
Mailing Address - Phone:417-863-9729
Mailing Address - Fax:417-863-0720
Practice Address - Street 1:1678 S FARM ROAD 133
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1013
Practice Address - Country:US
Practice Address - Phone:417-863-9729
Practice Address - Fax:417-863-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO26-9808335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOX22788Medicare UPIN