Provider Demographics
NPI:1871593541
Name:MOBILE X-RAY IMAGING INC.
Entity type:Organization
Organization Name:MOBILE X-RAY IMAGING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GELBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-561-4940
Mailing Address - Street 1:945 EAST PARK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111
Mailing Address - Country:US
Mailing Address - Phone:717-561-4940
Mailing Address - Fax:717-561-4467
Practice Address - Street 1:945 EAST PARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111
Practice Address - Country:US
Practice Address - Phone:717-561-4940
Practice Address - Fax:717-561-4467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA247100000X
261QR0208X, 335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA604810100OtherACS PROVIDER ID
PA0015231320004Medicaid
PA130594OtherMED-PLUS NON-PAR ID
50002712OtherCAPITAL
PA027624300OtherFEDERAL BLACK LUNG ID
P00093629OtherRAILROAD
310243OtherHIGHMARK
PA0015231320004Medicaid
PA604810100OtherACS PROVIDER ID