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General NPI Number Information
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NPI Number | 1740071265
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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 | 05/14/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 949 MARKET ST STE 602
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City | TACOMA
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State | WA
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Zip | 98402-3693
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Country | US
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Telephone | 253-271-9720
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Fax |
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Provider Business Mailing Address
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Address Line | 3825 N LAFAYETTE ST
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City | DENVER
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State | CO
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Zip | 80205-3316
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AO/OGC
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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 | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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