Basic Information
| Provider Information | |||||||||
| NPI: | 1912206392 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUPERIOR MOBILE IMAGING INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 US HIGHWAY 43 | ||||||||
| Address2: | |||||||||
| City: | WINFIELD | ||||||||
| State: | AL | ||||||||
| PostalCode: | 355945062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054124931 | ||||||||
| FaxNumber: | 2054871114 | ||||||||
| Practice Location | |||||||||
| Address1: | 1860 US HIGHWAY 43 | ||||||||
| Address2: | |||||||||
| City: | WINFIELD | ||||||||
| State: | AL | ||||||||
| PostalCode: | 355945062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054124931 | ||||||||
| FaxNumber: | 2054871114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2011 | ||||||||
| LastUpdateDate: | 03/24/2011 | ||||||||
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| AuthorizedOfficialLastName: | AYERS | ||||||||
| AuthorizedOfficialFirstName: | EDDIE | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | RADIOLOGIC TECHNOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 2054124931 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | R.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 335V00000X | 6728121 | AL | Y | Suppliers | Portable X-Ray Supplier |
No ID Information.