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NPI Code Detail

MEDICARE: PROFESSIONAL PORTABLE RADIOLOGIC SERVICES, INC.

MEDICARE: PROFESSIONAL PORTABLE RADIOLOGIC SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1335V00000XPortable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number : 1366747040
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL PORTABLE RADIOLOGIC SERVICES, INC.
Provider Business Mailing Address
First Line : 755 CLIFF RD E STE 200
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337-1536
Country : US
Telephone Number : 866-895-2119
Fax Number : 952-890-9025
Provider Business Practice Location Address
First Line : 376 E WARM SPRINGS RD STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-4241
Country : US
Telephone Number : 866-895-2120
Fax Number :
Authorized Official
Title or Position : VP - AO
Name : BRUCE ALLEN JOHNSON
Credential :
Telephone Number : 303-589-4149
Provider Enumeration Date : 01/11/2011
Last Update Date : 03/31/2025

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