Medical Mobile Imaging, LLC

Primary specialty

Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X

Legal business name

MEDICAL MOBILE IMAGING, LLC

Practice address

972 Chambers St Ste 7
South Ogden, UT 84403-4873

Phone

(801) 710-9023

NPI assigned

Feb 7, 2024

Last updated

Feb 13, 2024By 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

Tanya Jensen, RT(R)(CT)

Title

Business Owner

Phone

(801) 710-9023

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790549152. Details of each certification follow.

• CCN 46X0009813 Portable X-ray supplier · Active · Name & address match · Details

Portable X-ray supplier certification: CCN 46X0009813

Legal name

MEDICAL MOBILE IMAGING LLC

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Jul 17, 2024

Last certification

Jul 17, 2024

Ownership / control type

Partnership

Facility address

972 East Chambers Street, Suite 7
South Ogden, UT 84403

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

{
    "created_epoch": "1707264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707782400000",
    "number": "1790549152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "972 CHAMBERS ST STE 7",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "844034873",
            "telephone_number": "801-710-9023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "972 CHAMBERS ST STE 7",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "844034873",
            "telephone_number": "801-710-9023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL MOBILE IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-07",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "BUSINESS OWNER",
        "authorized_official_telephone_number": "801-710-9023",
        "authorized_official_credential": "RT(R)(CT)"
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Abigail McBride, RBT
• Karen McBride, CNM
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• Violet Clara Merten
• Brian D Miles, D.M.D.
• Candace Miles
• Julia Miller, RBT
• Symera Miller, RBT

• Mobile Radiology Clinic/Center in South Ogden, UT
• Providers in South Ogden, UT by specialty
• Mobile Radiology Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; 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.