Organization
HANNIBAL MOBILE DIAGNOSTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON SELLE (ADMINISTRATOR)
(573) 221-7870
Entity
Organization
Contact information
Practice address
2910 ST. MARY'S AVE., HANNIBAL, MO 63401
(573) 221-7870
(573) 221-9323
Mailing address
2910 ST. MARY'S AVE., HANNIBAL, MO 63401
(573) 221-7870
(573) 221-9323
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
719255606
—
MO
01
—
P00126139
RAILROAD MEDICARE
MO
Enumeration date
12/08/2006
Last updated
07/21/2022
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