Organization
MOUNTAIN MOBILE DIAGNOSTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. J B SPURLOCK R.T. (R) (PRESIDENT/OWNER)
(606) 487-9114
Entity
Organization
Contact information
Practice address
725 HARDBURLY RD, BULAN, KY 41722-8907
(606) 487-9114
(606) 487-9114
Mailing address
PO BOX 896, BULAN, KY 41722-0896
(606) 487-9114
(606) 487-9114
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
720142
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000073435
ANTHEM BC & BS
KY
01
—
155799
UMWA
KY
01
—
630001411
PALMETTO GBA, RRMC
KY
05
—
86089034
—
KY
Enumeration date
07/06/2006
Last updated
12/01/2015
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