Provider Demographics
NPI:1871899799
Name:SHERMIN MOBILE IMAGING, LLC
Entity type:Organization
Organization Name:SHERMIN MOBILE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-373-6176
Mailing Address - Street 1:1879 LUNDY AVE STE 218
Mailing Address - Street 2:SUITE 218
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1881
Mailing Address - Country:US
Mailing Address - Phone:408-373-6176
Mailing Address - Fax:408-684-4531
Practice Address - Street 1:1879 LUNDY AVE STE 218
Practice Address - Street 2:SUITE 218
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1881
Practice Address - Country:US
Practice Address - Phone:408-373-6176
Practice Address - Fax:408-684-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFAC00069861261QR0200X
CA261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology