Healthcare Provider Details

I. General information

NPI: 1093759276
Provider Name (Legal Business Name): PORTABLE MEDICAL DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 FOREST HILL BLVD STE 112
WEST PALM BEACH FL
33406-5878
US

IV. Provider business mailing address

3540 FOREST HILL BLVD STE 112
WEST PALM BEACH FL
33406-5878
US

V. Phone/Fax

Practice location:
  • Phone: 561-964-3311
  • Fax: 561-964-3199
Mailing address:
  • Phone: 561-964-3311
  • Fax: 561-964-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberHCC4152
License Number StateFL

VIII. Authorized Official

Name: ANDREW ROSEBROUGH
Title or Position: OWNER
Credential:
Phone: 561-964-3311