MEDICARE: ALLIED PORTABLE X-RAY 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	261QR0208X	Mobile Radiology Clinic/Center	435970	MN

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

General Provider Information

NPI Number	:	1104225531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIED PORTABLE X-RAY INC

Provider Business Mailing Address
First Line	:	1255 FILER AVE E STE C
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4118
Country	:	US
Telephone Number	:	855-364-6243
Fax Number	:	855-463-3211

Provider Business Practice Location Address
First Line	:	1255 FILER AVE E STE C
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4118
Country	:	US
Telephone Number	:	855-364-6243
Fax Number	:	855-463-3211

Authorized Official
Title or Position	:	PRESIDENT/ OWNER
Name	:	CARLEE STIEGLITZ-LEATHAM
Credential	:
Telephone Number	:	855-364-6243

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	02/29/2024

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