=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841592656
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAST RESPONSE PORTABLE IMAGING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2010
-----------------------------------------------------
Last Update Date | 07/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 N MYRTLE AVE
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33755-4533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-337-6101
-----------------------------------------------------
Fax | 727-213-6250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 CHALLENGER RD SUITE 100
-----------------------------------------------------
City | RIDGEFIELD PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07660-2108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-337-6101
-----------------------------------------------------
Fax | 727-213-6250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SAM WEINBERG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 914-263-3745
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number | HCC9044
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 335V00000X
-----------------------------------------------------
Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
-----------------------------------------------------
License Number | HCC9044
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------