Organization
QUALITY MOBILE X-RAY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CALEB FORT (CEO)
(336) 245-0647
Entity
Organization
Contact information
Practice address
3330 HEALY DR STE 100, WINSTON SALEM, NC 27103-2024
(336) 245-0647
(336) 245-0649
Mailing address
3330 HEALY DRIVE, SUITE 100, WINSTON SALEM, NC 27103
(336) 245-0647
(336) 245-0649
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
34X0009827
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015GC
BCBS
NC
05
—
3409802
—
NC
01
—
P00053144
MEDICARE RAILROAD
NC
Enumeration date
10/04/2006
Last updated
06/07/2017
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