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General NPI Number Information
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NPI Number | 1891125936
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Entity Type | Organization
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Legal Business Name | PORTABLE MEDICAL DIAGNOSTICS, INC
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Dates
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Enumeration Date | 11/26/2013
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | 3540 FOREST HILL BLVD STE 112
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-5878
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Country | US
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Telephone | 561-964-3311
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Fax | 561-964-3199
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Provider Business Mailing Address
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Address Line | 3540 FOREST HILL BLVD STE 112
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-5878
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Country | US
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Telephone | 561-964-3311
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Fax | 561-964-3199
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Authorized Official
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Title or Position | VP, CFO
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Name | MR. ANDREW ROSEBROUGH
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Credential | BSA
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Telephone | 561-964-3311
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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 | HCC4152
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License Number State | FL
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Taxonomy #2
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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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