Organization
ELITE MOBILE DIAGNOSTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL WOELKERS (PRESIDENT)
(570) 346-5115
Entity
Organization
Contact information
Practice address
1229 MONROE AVE, DUNMORE, PA 18509-2807
(800) 789-7082
(800) 789-7082
Mailing address
1229 MONROE AVE, DUNMORE, PA 18509-2807
(800) 789-7082
(800) 789-7082
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2521177
—
OH
05
—
6802015000
—
WV
05
—
86000411
—
KY
01
—
P00137989
RAILROAD MEDICARE
WV
01
—
P00137995
RAILROAD MEDICARE
OH
01
—
P00137998
RAILROAD MEDICARE
KY
Enumeration date
05/31/2006
Last updated
10/30/2007
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