MEDICARE: PORTABLE MEDICAL DIAGNOSTICS INC

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
1	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	HCC4152	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093759276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTABLE MEDICAL DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	3540 FOREST HILL BLVD STE 112
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5878
Country	:	US
Telephone Number	:	561-964-3311
Fax Number	:	561-964-3199

Provider Business Practice Location Address
First Line	:	3540 FOREST HILL BLVD STE 112
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5878
Country	:	US
Telephone Number	:	561-964-3311
Fax Number	:	561-964-3199

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW ROSEBROUGH
Credential	:
Telephone Number	:	561-964-3311

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	04/04/2024

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Directions to “PORTABLE MEDICAL DIAGNOSTICS INC ” Practice Location

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