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General NPI Number Information
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NPI Number | 1689813255
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PORTABLE RADIOLOGIC SERVICES, INC.
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Dates
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Enumeration Date | 02/05/2009
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 421 W BROADWAY STE 403
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-9046
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Country | US
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Telephone | 866-895-2120
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Fax |
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Provider Business Mailing Address
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Address Line | 755 CLIFF RD E
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City | BURNSVILLE
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State | MN
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Zip | 55337-1545
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Country | US
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Telephone | 612-369-1991
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Fax | 952-890-9025
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Authorized Official
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Title or Position | VP-AO
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Name | BRUCE ALLEN JOHNSON
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Credential |
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Telephone | 303-589-4149
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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 | IA
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