Healthcare Provider Details

I. General information

NPI: 1497894539
Provider Name (Legal Business Name): M&M PORTABLE X-RAY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 04/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MCKINLEY AVE
EL PASO TX
79930-2240
US

IV. Provider business mailing address

PO BOX 221495
EL PASO TX
79913-4495
US

V. Phone/Fax

Practice location:
  • Phone: 915-562-3444
  • Fax:
Mailing address:
  • Phone: 915-588-2645
  • Fax: 915-584-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number8969
License Number StateTX

VIII. Authorized Official

Name: MR. AJAY K SHARMA
Title or Position: MANAGER
Credential: R.T.
Phone: 915-588-2645