Hannibal Mobile Diagnostics, LLC

Primary specialty

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

Legal business name

HANNIBAL MOBILE DIAGNOSTICS, LLC

Practice address

2910 St. Mary's Ave.
Hannibal, MO 63401

Phone

(573) 221-7870

Fax

(573) 221-9323

NPI assigned

Dec 8, 2006

Last updated

Jul 21, 2022By 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

Brandon Selle

Title

Administrator

Phone

(573) 221-7870

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO, IL2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417016114. Details of each certification follow.

• CCN 26X0009836 Portable X-ray supplier · Active · Name & address match · Details

Portable X-ray supplier certification: CCN 26X0009836

Legal name

HANNIBAL MOBILE DIAGNOSTICS, LLC

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

May 11, 2004

Last certification

Oct 22, 2014

Ownership / control type

OTHER THAN PRIVATE

Facility address

2910 St Mary's Ave
Hannibal, MO 63401

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Hannibal Regional Healthcare System, Inc

  • Rural Health Clinic/Center
  • Bowling Green, MO
  • NPI 1700806130

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1417016114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2910 ST. MARY'S AVE.",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "63401",
            "telephone_number": "573-221-7870",
            "fax_number": "573-221-9323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2910 ST. MARY'S AVE.",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "63401",
            "telephone_number": "573-221-7870",
            "fax_number": "573-221-9323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HANNIBAL MOBILE DIAGNOSTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SELLE",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "573-221-7870"
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "719255606",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00126139",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannibal Council on Alcohol & Drug Abuse
• Hannibal Council on Alcohol and Drug Abuse
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• Hannibal Health & Rehabilitation Center, Inc.
• Hannibal Medical Supplies, LLC
• Hannibal Regional Healthcare System Inc
• Hannibal Regional Healthcare System Inc (Hannibal Regional Inpatient Rehabilitation)
• Hannibal Regional Healthcare System, Inc (Hannibal Regional Medical Group)
• Hannibal Regional Healthcare System, Inc (Hannibal Regional Medical Group)
• Hannibal Regional Healthcare System, Inc

• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Hannibal, MO
• Providers in Hannibal, MO by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Missouri

• 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; 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.