Basic Information
| Provider Information | |||||||||
| NPI: | 1003804345 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOBILE MOLECULAR IMAGING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7687 | ||||||||
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| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366700627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514600243 | ||||||||
| FaxNumber: | 2514600375 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MEMORIAL HOSPITAL DR | ||||||||
| Address2: | STE 1E | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513163868 | ||||||||
| FaxNumber: | 2513163583 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 12/15/2006 | ||||||||
| NPIReactivationDate: | 01/09/2007 | ||||||||
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| AuthorizedOfficialLastName: | ZURFLUH | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2516330573 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
No ID Information.