Organization
MOBILE MEDICAL IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL STEVEN JACOBUS RT(ARRT) (OWNER)
(803) 917-2988
Entity
Organization
Contact information
Practice address
1127 OLD RD, CHAPIN, SC 29036-8512
(803) 917-2988
(803) 781-0077
Mailing address
1127 OLD RD, CHAPIN, SC 29036-8512
(803) 917-2988
(803) 781-0077
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
01
—
300005574
TRAVELERS MEDICARE RAILRO
SC
05
—
498018
—
SC
Enumeration date
11/16/2007
Last updated
03/23/2016
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