Organization
GULF COAST MOBILE IMAGING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEANNA FASELT VICE PRESIDENT (OWNER)
(702) 839-1133
Entity
Organization
Contact information
Practice address
7020 HIGHWAY 190 STE A, COVINGTON, LA 70433-4962
(337) 594-9637
Mailing address
2490 PROFESSIONAL CT STE 110, LAS VEGAS, NV 89128-0835
(702) 839-1133
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
088168
LA
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2100041
—
LA
Enumeration date
01/22/2007
Last updated
06/17/2022
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