Healthcare Provider Details

I. General information

NPI: 1053642314
Provider Name (Legal Business Name): FAST RESPONSE PORTABLE IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4658 LITWIN ST # A
FORT CAMPBELL KY
42223
US

IV. Provider business mailing address

4658 LITWIN ST #A
FORT CAMPBELL KY
42223
US

V. Phone/Fax

Practice location:
  • Phone: 270-348-0411
  • Fax: 270-640-8276
Mailing address:
  • Phone: 270-348-0411
  • Fax: 270-640-8276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MARGARETTE LOUINE
Title or Position: OWNER
Credential:
Phone: 270-348-0411