Healthcare Provider Details

I. General information

NPI: 1073476461
Provider Name (Legal Business Name): ALL-STAT PORTABLE MO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W PINE ST
POPLAR BLUFF MO
63901-5045
US

IV. Provider business mailing address

8235 CHRISTIANA AVE
SKOKIE IL
60076-2910
US

V. Phone/Fax

Practice location:
  • Phone: 224-337-1000
  • Fax:
Mailing address:
  • Phone: 224-337-1000
  • Fax:

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: ETAI SOOLIMAN
Title or Position: CEO
Credential:
Phone: 227-337-1000