Provider Demographics
NPI:1730351255
Name:QUALITY MOBILE X-RAY SERVICES, INC.
Entity type:Organization
Organization Name:QUALITY MOBILE X-RAY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-371-0073
Mailing Address - Street 1:PO BOX 110359
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37222-0359
Mailing Address - Country:US
Mailing Address - Phone:615-391-4515
Mailing Address - Fax:303-785-9283
Practice Address - Street 1:640 GRASSMERE PARK
Practice Address - Street 2:SUITE 116
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3678
Practice Address - Country:US
Practice Address - Phone:615-391-4515
Practice Address - Fax:303-785-9283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR188428710Medicaid
KY86000056Medicaid
MS557319Medicaid
AR188428710Medicaid
MS557319Medicaid
KY86000056Medicaid
AR5G877Medicare PIN