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General NPI Number Information
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NPI Number | 1063742211
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Entity Type | Organization
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Legal Business Name | VERIZON PORTABLE XRAY SERVICE INC.
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 350 FM 145
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City | EARTH
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State | TX
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Zip | 79031-2110
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Country | US
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Telephone | 806-240-0965
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Fax |
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Provider Business Mailing Address
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Address Line | 350 FM 145
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City | EARTH
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State | TX
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Zip | 79031-2110
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Country | US
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Telephone | 806-240-0965
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Fax |
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Authorized Official
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Title or Position | RADIOLOGIC TECHNOLOGIST/OWNER
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Name | MR. SAMUEL JAMES OTT I
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Credential | R.T.R
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Telephone | 806-240-0965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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