Provider Demographics
NPI:1174577969
Name:MOBILE MEDICAL IMAGING, LLC
Entity type:Organization
Organization Name:MOBILE MEDICAL IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:301-680-1900
Mailing Address - Street 1:12501 PROSPERITY DR
Mailing Address - Street 2:SUITE 455
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1689
Mailing Address - Country:US
Mailing Address - Phone:301-680-1900
Mailing Address - Fax:301-680-0920
Practice Address - Street 1:12501 PROSPERITY DR
Practice Address - Street 2:SUITE 455
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1689
Practice Address - Country:US
Practice Address - Phone:301-680-1900
Practice Address - Fax:301-680-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC025431800Medicaid
VA004991249Medicaid
630000633OtherRAILROAD MEDICARE PIN
MD4234804 00Medicaid
MD698RMedicare PIN
DC025431800Medicaid
630000633OtherRAILROAD MEDICARE PIN
MD698RMedicare PIN
DCFDCB01Medicare PIN
VA086161OtherBLUECROSS BLUESHIELD
DCB555OtherBLUECROSS BLUESHIELD
VA630000010Medicare PIN
MD696RMedicare PIN
W59702Medicare UPIN