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General NPI Number Information
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NPI Number | 1619204203
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Entity Type | Organization
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Legal Business Name | PIONEER MEDICAL PORTABLE XRAY,LLC
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Dates
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Enumeration Date | 11/03/2009
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Last Update Date | 11/10/2009
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Provider Practice Location Address
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Address Line | 100 CLARENDON AVE
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City | PETAL
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State | MS
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Zip | 39465-2636
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Country | US
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Telephone | 601-550-4611
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Fax | 601-510-9449
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Provider Business Mailing Address
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Address Line | 100 CLARENDON AVE
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City | PETAL
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State | MS
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Zip | 39465-2636
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Country | US
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Telephone | 601-550-4611
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Fax | 601-510-9449
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Authorized Official
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Title or Position | OWNER
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Name | TED H CRABTREE JR.
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Credential | RT
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Telephone | 601-550-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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