Elite Mobile Diagnostic Services

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

Legal business name

ELITE MOBILE DIAGNOSTIC SERVICES

Practice address

1229 Monroe Ave
Dunmore, PA 18509-2807

Phone

(800) 789-7082

Fax

(800) 789-7082

NPI assigned

May 31, 2006

Last updated

Oct 30, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Paul Woelkers

Title

President

Phone

(570) 346-5115

Specialties & licenses 1

Addresses

Other identifiers 6

Locations

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193702400000",
    "number": "1063469260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 MONROE AVE",
            "city": "DUNMORE",
            "state": "PA",
            "postal_code": "185092807",
            "telephone_number": "800-789-7082",
            "fax_number": "800-789-7082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 MONROE AVE",
            "city": "DUNMORE",
            "state": "PA",
            "postal_code": "185092807",
            "telephone_number": "800-789-7082",
            "fax_number": "800-789-7082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE MOBILE DIAGNOSTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2007-10-30",
        "status": "A",
        "authorized_official_last_name": "WOELKERS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-346-5115",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6802015000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00137989",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00137995",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00137998",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2521177",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "86000411",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Dunmore, PA
• Providers in Dunmore, PA by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; 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.