Provider Demographics
NPI:1902916448
Name:MOBILE DIAGNOSTIC TESTING SERVICES INC
Entity Type:Organization
Organization Name:MOBILE DIAGNOSTIC TESTING SERVICES INC
Other - Org Name:HEALTHTRAC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-614-3285
Mailing Address - Street 1:4950 GENESEE ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14225-5550
Mailing Address - Country:US
Mailing Address - Phone:716-614-3260
Mailing Address - Fax:716-614-3282
Practice Address - Street 1:4950 GENESEE ST
Practice Address - Street 2:SUITE 180
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14225-5550
Practice Address - Country:US
Practice Address - Phone:716-614-3260
Practice Address - Fax:716-614-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-11-04
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
NY0073926OtherGHI
NY00020000502OtherUNIVERA
NY000510159003OtherBCBS WNY
NY7602181OtherIHA
NY01712505Medicaid
NY01867490Medicaid
NY630000672Medicare PIN
NY630000690Medicare PIN
NY7602181OtherIHA
NY01867490Medicaid