NPIMap

Organization Active NPI

Mobile Diagnostic Services, Inc

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Dunlap, IL
National Provider Identifier
1043320724
Registry record updated Apr 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X
License
335V00000X Issued in IL
Legal business name
MOBILE DIAGNOSTIC SERVICES, INC
Practice address
1719 W Woodside Dr
Dunlap, IL 61525-9572
Phone
(309) 689-0243
Fax
(309) 689-0205
NPI assigned
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mindy Moore
Title
Vice President
Phone
(309) 689-0243

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X 335V00000X IL Primary

Addresses

Primary practice location

1719 W Woodside Dr
Dunlap, IL 61525-9572

Mailing address

1719 W Woodside Dr
Dunlap, IL 61525-9572
Phone (309) 689-0243

Other identifiers 1

IdentifierTypeStateIssuer
0259648MedicaidIA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335139200000",
    "number": "1043320724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1719 W WOODSIDE DR",
            "city": "DUNLAP",
            "state": "IL",
            "postal_code": "615259572",
            "telephone_number": "309-689-0243",
            "fax_number": "309-689-0205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 W WOODSIDE DR",
            "city": "DUNLAP",
            "state": "IL",
            "postal_code": "615259572",
            "telephone_number": "309-689-0243",
            "fax_number": "309-689-0205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE DIAGNOSTIC SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2012-04-23",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MINDY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "309-689-0243"
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "IL",
            "license": "335V00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0259648",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunlap, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.