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General NPI Number Information
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NPI Number | 1871234815
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Entity Type | Organization
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Legal Business Name | ALL-STAT PORTABLE MI LLC
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 515 SHIP ST STE 209
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-1155
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Country | US
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Telephone | 224-337-1203
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Fax | 224-337-1204
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Provider Business Mailing Address
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Address Line | 8235 CHRISTIANA AVE
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City | SKOKIE
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State | IL
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Zip | 60076-2910
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Country | US
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Telephone | 224-337-1000
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Fax | 224-337-1204
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Authorized Official
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Title or Position | CEO
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Name | MR. ETAI SOOLIMAN
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Credential |
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Telephone | 224-337-1000
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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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Taxonomy #2
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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