Provider Demographics
NPI:1902137904
Name:MOBILE MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:MOBILE MEDICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LECLERCQ
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:239-793-1790
Mailing Address - Street 1:7907 FOUNDERS CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-5341
Mailing Address - Country:US
Mailing Address - Phone:239-793-1790
Mailing Address - Fax:239-793-1790
Practice Address - Street 1:7907 FOUNDERS CIR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-5341
Practice Address - Country:US
Practice Address - Phone:239-793-1790
Practice Address - Fax:239-793-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory