Healthcare Provider Details

I. General information

NPI: 1033780051
Provider Name (Legal Business Name): PROFESSIONAL PORTABLE RADIOLOGIC SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5421 BEAUMONT CENTER BLVD STE 670
TAMPA FL
33634-5223
US

IV. Provider business mailing address

755 CLIFF RD E
BURNSVILLE MN
55337-1545
US

V. Phone/Fax

Practice location:
  • Phone: 866-895-2119
  • Fax: 952-915-9779
Mailing address:
  • Phone: 866-895-2119
  • Fax: 952-890-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM KRAMER
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 215-813-5940