Mobile X-Ray Service LLC

Primary specialty

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

Legal business name

MOBILE X-RAY SERVICE LLC

Practice address

1014 School Ave
Walla Walla, WA 99362-1497

Phone

(509) 527-1274

NPI assigned

Mar 1, 2007

Last updated

Jun 4, 2008By 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

Mrs. Laura J Schmidt

Title

Owner

Phone

(509) 527-1274

Specialties & licenses 1

Addresses

Other identifiers 1

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 1578691689. Details of each certification follow.

• CCN 50X0009830 Portable X-ray supplier · Active · Name & address match · Details

Portable X-ray supplier certification: CCN 50X0009830

Legal name

MOBILE X-RAY SERVICE LLC

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Aug 9, 2007

Last certification

Aug 9, 2007

Ownership / control type

OTHER THAN PRIVATE

Facility address

1014 School Avenue
Walla Walla, WA 99362

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212537600000",
    "number": "1578691689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 SCHOOL AVE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993621497",
            "telephone_number": "509-527-1274",
            "fax_number": "509-522-4938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 SCHOOL AVE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993621497",
            "telephone_number": "509-527-1274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE X-RAY SERVICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2008-06-04",
        "status": "A",
        "authorized_official_last_name": "SCHMIDT",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-527-1274",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LAGACY PROVIDER",
            "identifier": "G8866053",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2008; 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.