Provider Demographics
NPI:1679924807
Name:PATRIOT MOBILE IMAGING, LLC
Entity type:Organization
Organization Name:PATRIOT MOBILE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-644-6727
Mailing Address - Street 1:2201 MAIN ST
Mailing Address - Street 2:SUITE 1299
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4327
Mailing Address - Country:US
Mailing Address - Phone:214-760-1661
Mailing Address - Fax:214-760-1667
Practice Address - Street 1:2201 MAIN ST
Practice Address - Street 2:SUITE 1299
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4327
Practice Address - Country:US
Practice Address - Phone:214-760-1661
Practice Address - Fax:214-760-1667
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATRIOT INNOVATIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-29
Last Update Date:2016-08-30
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
TX494088Medicare PIN