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General NPI Number Information
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NPI Number | 1689953978
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Entity Type | Organization
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Legal Business Name | LOCAL PORTABLE IMAGING LLC
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 08/04/2011
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Provider Practice Location Address
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Address Line | 405 MOUNTAIN MEADOW CIR
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City | HEMPHILL
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State | TX
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Zip | 75948-3643
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Country | US
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Telephone | 409-625-1574
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Fax | 409-625-0985
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Provider Business Mailing Address
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Address Line | 405 MOUNTAIN MEADOW CIR
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City | HEMPHILL
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State | TX
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Zip | 75948-3643
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Country | US
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Telephone | 409-625-1574
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Fax | 405-625-0985
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Authorized Official
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Title or Position | OWNER
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Name | MIKE GIBBS
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Credential |
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Telephone | 409-625-1574
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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 | R35279
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License Number State | TX
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