Provider Demographics
NPI:1538159819
Name:ALLIED MOBILE SONO, INC.
Entity type:Organization
Organization Name:ALLIED MOBILE SONO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:LENNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-247-2674
Mailing Address - Street 1:3545 SAINT JOHNS BLUFF RD S
Mailing Address - Street 2:SUITE 1 # 274
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2682
Mailing Address - Country:US
Mailing Address - Phone:904-247-2674
Mailing Address - Fax:904-247-3944
Practice Address - Street 1:3545 SAINT JOHNS BLUFF RD S
Practice Address - Street 2:SUITE 1 # 274
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2682
Practice Address - Country:US
Practice Address - Phone:904-247-2674
Practice Address - Fax:904-247-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6630261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
V3066OtherFLORIDA BC/BS
FLU6113Medicare ID - Type UnspecifiedMEDICARE PART B
V3066OtherFLORIDA BC/BS