Healthcare Provider Details

I. General information

NPI: 1447061908
Provider Name (Legal Business Name): PROFESSIONAL PORTABLE RADIOLOGIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17527 NASSAU COMMONS BLVD STE 112
LEWES DE
19958-6283
US

IV. Provider business mailing address

3825 N LAFAYETTE ST
DENVER CO
80205-3316
US

V. Phone/Fax

Practice location:
  • Phone: 866-895-2120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: BRUCE JOHNSON
Title or Position: VP/OGC
Credential:
Phone: 303-589-4149