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NPI Code Detail

MEDICARE: PORTABLE X RAY OF SOUTHERN NEVADA

MEDICARE: PORTABLE X RAY OF SOUTHERN NEVADA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0208XMobile Radiology Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NV3524OTHERNVNV BLUE SHIELD

General Provider Information

NPI Number : 1083692032
Entity Type Code : Organization
Provider Name (Legal Business Name) : PORTABLE X RAY OF SOUTHERN NEVADA
Provider Business Mailing Address
First Line : 5538 DUNCAN DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-2812
Country : US
Telephone Number : 702-645-2606
Fax Number : 702-645-1478
Provider Business Practice Location Address
First Line : 5488 DUNCAN DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-2812
Country : US
Telephone Number : 702-655-0535
Fax Number : 702-655-0538
Authorized Official
Title or Position : CFO
Name : ABBY GROSSA
Credential :
Telephone Number : 702-939-6559
Provider Enumeration Date : 01/09/2006
Last Update Date : 04/20/2008

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Directions to “PORTABLE X RAY OF SOUTHERN NEVADA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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