Provider Demographics
NPI:1538491113
Name:LOST PINES MOBILE IMAGING LLC
Entity type:Organization
Organization Name:LOST PINES MOBILE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAI
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-841-1113
Mailing Address - Street 1:2101 SHANNON OXMOOR RD # 67
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:AL
Mailing Address - Zip Code:35142-2000
Mailing Address - Country:US
Mailing Address - Phone:888-212-4243
Mailing Address - Fax:205-847-5262
Practice Address - Street 1:4337 LINDBERGH DR
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4539
Practice Address - Country:US
Practice Address - Phone:972-224-1329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45X0009916Medicare Oscar/Certification
TX45X0009916Medicare UPIN