Provider Demographics
NPI:1053737130
Name:GENESIS MOBILE X-RAY, LLC
Entity type:Organization
Organization Name:GENESIS MOBILE X-RAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAVEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-522-1002
Mailing Address - Street 1:110 W RANDOL MILL RD
Mailing Address - Street 2:STE 228
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4611
Mailing Address - Country:US
Mailing Address - Phone:817-522-1002
Mailing Address - Fax:
Practice Address - Street 1:110 W RANDOL MILL RD
Practice Address - Street 2:STE 228
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4611
Practice Address - Country:US
Practice Address - Phone:817-522-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR38642OtherDSHS