NPIMap

Organization Active NPI

Mobile Visions Inc

  • Physiological Laboratory
  • Winston Salem, NC
National Provider Identifier
1326009457
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
MOBILE VISIONS INC
Practice address
3330 Healy Dr Ste 100
Winston Salem, NC 27103-2024
Phone
(336) 245-0647
Fax
(336) 245-0649
NPI assigned
Mar 29, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Caleb C Fort
Title
Ceo
Phone
(336) 245-0647

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X NU Primary

Addresses

Primary practice location

3330 Healy Dr Ste 100
Winston Salem, NC 27103-2024

Mailing address

7820 N Point Blvd Ste 101
Winston Salem, NC 27106-3299
Phone (336) 245-0647

Other identifiers 1

IdentifierTypeStateIssuer
8105027MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060228000631 NC Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 4385686401 Practice locations: Winston Salem, NC
O20160615000018 SC Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 4385686401 Practice locations: Spartanburg, SC

National Provider Directory

National Provider Directory

Locations

172 E Main St
Spartanburg, SC 29306
Phone (800) 243-9976

5 E Church St
#105
Martinsville, VA 24112
Phone (800) 243-9976

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1326009457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7820 N POINT BLVD STE 101",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063299",
            "telephone_number": "336-245-0647",
            "fax_number": "336-245-0649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 HEALY DR STE 100",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032024",
            "telephone_number": "336-245-0647",
            "fax_number": "336-245-0649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE VISIONS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "FORT",
        "authorized_official_first_name": "CALEB",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-245-0647",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8105027",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.