Mobile Medical Diagnostic Services

Primary specialty

Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X

License

00419 Issued in IA

Legal business name

MOBILE MEDICAL DIAGNOSTIC SERVICES

Practice address

6223 Highway 63
Ottumwa, IA 52501-8175

Phone

(641) 777-1363

Fax

(641) 682-6836

NPI assigned

Jul 15, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Darin Lee Delker

Title

Owner

Phone

(641) 777-1363

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Portable X-ray supplier certification: CCN 16X0009810

Legal name

MOBILE MEDICAL DIAGNOSTIC SERVICES

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Jul 23, 1996

Last certification

Nov 24, 2020

Ownership / control type

Corporation

Most recent change of ownership

Sep 1, 1998

Facility address

6223 Highway 63 South
Ottumwa, IA 52501

Locations

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365379200000",
    "number": "1306845094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6223 HIGHWAY 63",
            "city": "OTTUMWA",
            "state": "IA",
            "postal_code": "525018175",
            "telephone_number": "641-777-1363",
            "fax_number": "641-682-6836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6223 HIGHWAY 63",
            "city": "OTTUMWA",
            "state": "IA",
            "postal_code": "525018175",
            "telephone_number": "641-777-1363",
            "fax_number": "641-682-6836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE MEDICAL DIAGNOSTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-15",
        "last_updated": "2013-04-08",
        "status": "A",
        "authorized_official_last_name": "DELKER",
        "authorized_official_first_name": "DARIN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "641-777-1363",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": "IA",
            "license": "00419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BC/BS OF IOWA",
            "identifier": "45171",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0265850",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "630001464",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Milestones Area Agency on Aging
• Debra Kay Miller, MD
• Joseph R. Miller Jr., PHARMD
• Pamela Sue Miller, ARNP
• William Peyton Miller, MD FAAP
• Tyna Monohon
• Michelle April Moon, PHARMD
• Moore Hearing Clinic PC
• Bret A Moore, PA-C
• Gregory Kim Moore, AUD

• Mobile Radiology Clinic/Center in Ottumwa, IA
• Providers in Ottumwa, IA by specialty
• Mobile Radiology Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.