Mobileradiology.Org LLC

Primary specialty

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

License

XT010239 Issued in IN

Legal business name

MOBILERADIOLOGY.ORG LLC

Doing business as

Source Diagnostics of Indiana

Practice address

13645 McKinley Hwy
Unit a
Mishawaka, IN 46545-7492

Phone

(574) 274-2300

NPI assigned

Apr 8, 2009

Organization subpart

No

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

Authorized official

Name

Ms. Kathleen A Barry

Title

Coo

Phone

(440) 645-7822

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Source Diagnostics of Indiana Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Albert James Cook Sr., M.D.

  • Diagnostic Radiology Physician
  • Seaman, OH
  • NPI 1114957792
  NPD (past)

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

{
    "created_epoch": "1239148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331683200000",
    "number": "1922241835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5275 NAIMAN RD",
            "address_2": "SUITE E",
            "city": "SOLON",
            "state": "OH",
            "postal_code": "441391033",
            "telephone_number": "440-645-7822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13645 MCKINLEY HWY",
            "address_2": "UNIT A",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465457492",
            "telephone_number": "574-274-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILERADIOLOGY.ORG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-08",
        "last_updated": "2012-03-14",
        "status": "A",
        "authorized_official_last_name": "BARRY",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "440-645-7822",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "IN",
            "license": "XT010239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200943790",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Source Diagnostics of Indiana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rita M Mitcheff, LCSW
• Airiana Mitchell
• Sacha Lynn Mitchell
• Sonal Dhuper Mittal, MD
• MJ Counseling LLC
• Mobileradiology.Org, LLC
• Zeina Mohamed Refaat Mohamed Ali Rady
• Shaya Mokfi, M.D.
• Kevin Patrick Molloy, MS
• Kaylee Jo Momany

• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.