Innovative Mobile Services LLC

Primary specialty

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

License

18723 Issued in OK

Legal business name

INNOVATIVE MOBILE SERVICES LLC

Practice address

202 Miller Way
Monett, MO 65708-8336

Phone

(417) 434-4935

NPI assigned

Aug 18, 2008

Last updated

Sep 1, 2016By 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

James Kelly

Title

Owner

Phone

(417) 626-9729

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1528214913. Details of each certification follow.

• CCN 26X0009833 Portable X-ray supplier · Active · Name & address match · Details

Portable X-ray supplier certification: CCN 26X0009833

Legal name

INNOVATIVE MOBILE SERVICES

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Jun 26, 2003

Last certification

Jul 29, 2014

Ownership / control type

INDIVIDUAL

Facility address

202 Miller Way
Monett, MO 65708

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

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1528214913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2966",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648032966",
            "telephone_number": "417-626-9729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 MILLER WAY",
            "city": "MONETT",
            "state": "MO",
            "postal_code": "657088336",
            "telephone_number": "417-434-4935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE MOBILE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-18",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-626-9729"
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "OK",
            "license": "18723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528214913",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200251380A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Monett, MO
• Providers in Monett, 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 Sep 1, 2016; 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.