Healthcare Provider Details

I. General information

NPI: 1538257662
Provider Name (Legal Business Name): PROFESSIONAL MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10241 JUNIPER CREEK LN
LAS VEGAS NV
89145-8831
US

IV. Provider business mailing address

10241 JUNIPER CREEK LN
LAS VEGAS NV
89145-8831
US

V. Phone/Fax

Practice location:
  • Phone: 909-556-0349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ALEXANDER LEVKOFF
Title or Position: PRESIDENT
Credential:
Phone: 909-592-6345