Healthcare Provider Details

I. General information

NPI: 1104225531
Provider Name (Legal Business Name): ALLIED PORTABLE X-RAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 FILER AVE E STE C
TWIN FALLS ID
83301-4118
US

IV. Provider business mailing address

1255 FILER AVE E STE C
TWIN FALLS ID
83301-4118
US

V. Phone/Fax

Practice location:
  • Phone: 855-364-6243
  • Fax: 855-463-3211
Mailing address:
  • Phone: 855-364-6243
  • Fax: 855-463-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number435970
License Number StateMN

VIII. Authorized Official

Name: CARLEE STIEGLITZ-LEATHAM
Title or Position: PRESIDENT/ OWNER
Credential:
Phone: 855-364-6243