MEDICARE: PROFESSIONAL PORTABLE RADIOLOGIC SERVICES 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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1174228308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL PORTABLE RADIOLOGIC SERVICES INC.

Provider Business Mailing Address
First Line	:	3825 N LAFAYETTE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-3316
Country	:	US
Telephone Number	:	303-500-1518
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 HAND AVE STE A
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8195
Country	:	US
Telephone Number	:	303-500-1518
Fax Number	:

Authorized Official
Title or Position	:	CHIEF LEGAL OFFICER
Name	:	WILLIAM KRAMER
Credential	:
Telephone Number	:	215-813-5940

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	07/07/2025

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