Provider Demographics
NPI:1528305190
Name:MOBILE DIAGNOSTIC SERVICES, LLC
Entity type:Organization
Organization Name:MOBILE DIAGNOSTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-220-0720
Mailing Address - Street 1:3714 SW 12TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5115
Mailing Address - Country:US
Mailing Address - Phone:239-220-0720
Mailing Address - Fax:239-220-5525
Practice Address - Street 1:3714 SW 12TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-5115
Practice Address - Country:US
Practice Address - Phone:239-220-0720
Practice Address - Fax:239-220-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty