Healthcare Provider Details

I. General information

NPI: 1184602120
Provider Name (Legal Business Name): PORTABLE X RAY OF OREGON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10570 SE WASHINGTON ST SUITE 200
PORTLAND OR
97216
US

IV. Provider business mailing address

5538 W DUNCAN DR
LAS VEGAS NV
89130
US

V. Phone/Fax

Practice location:
  • Phone: 425-640-2600
  • Fax: 425-640-2174
Mailing address:
  • Phone: 702-645-2606
  • Fax: 702-645-2874

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. CAROL TOOMEY
Title or Position: MEMBER
Credential:
Phone: 702-645-2606