Healthcare Provider Details

I. General information

NPI: 1437102480
Provider Name (Legal Business Name): PUTNAM XRAY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 N BEVERLY ST
PORTERVILLE CA
93257-1065
US

IV. Provider business mailing address

PO BOX 1866
PORTERVILLE CA
93258-1866
US

V. Phone/Fax

Practice location:
  • Phone: 559-782-1065
  • Fax:
Mailing address:
  • Phone: 559-782-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: RANDALL R MORRIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 559-782-1065