MEDICARE: PORTABLE X RAY OF ARIZONA LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2Z1598	OTHER	AZ	HEALTH NET
2	579055	OTHER	AZ	HEALTHCHOICE
3	579055	OTHER	AZ	AHCCCS
4	AW2888	OTHER	AZ	HEALTHNET
5	AZ0890990	OTHER	AZ	BULE CROSS BLUE SHIELD OF
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	65945	OTHER	AZ	SCAN
8	F10081	OTHER	AZ	PHOENIX HEALTH PLAN

General Provider Information

NPI Number	:	1336234772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTABLE X RAY OF ARIZONA LLC

Provider Business Mailing Address
First Line	:	5538 WEST DUNCAN DRIVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130
Country	:	US
Telephone Number	:	702-395-5011
Fax Number	:	702-645-2874

Provider Business Practice Location Address
First Line	:	2338 WEST ROYAL PALM DRIVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021
Country	:	US
Telephone Number	:	602-864-3656
Fax Number	:	602-864-3660

Authorized Official
Title or Position	:	CFO
Name	:	ABBY GROSSA
Credential	:
Telephone Number	:	702-395-5011

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	04/20/2008

Similar Medicare Providers

1215187570 — PORTABLE IMAGING OF ARIZONA, LLC
Practice Location Address:

2338 W ROYAL PALM RD , SUITE A
PHOENIX, AZ
85021-9339

Practice Phone: 602-864-3656
Practice Fax: 602-864-3660

1194650044 — PAIGE CORNELL
Practice Location Address:

2255 W NORTHERN AVE
PHOENIX, AZ
85021-4936

Practice Phone: 602-995-1767
Practice Fax:

1437084084 — UNITED INTEGRATED HEALTH LLC
Practice Location Address:

7550 N 19TH AVE STE 104
PHOENIX, AZ
85021-7982

Practice Phone: 480-803-6593
Practice Fax:

1508210006 — MISTY ANDERSEN-PITCHER LPC
Practice Location Address:

7219 N 23RD LN
PHOENIX, AZ
85021-7651

Practice Phone: 480-269-5666
Practice Fax:

1952000390 — CORNERSTONE CAREGIVING WEST LLC
Practice Location Address:

2224 W NORTHERN AVE STE D207
PHOENIX, AZ
85021-4928

Practice Phone: 623-500-6737
Practice Fax:

1336837616 — IDEAL TREATMENT CENTER LLC
Practice Location Address:

1717 W NORTHERN AVE STE 107
PHOENIX, AZ
85021-5400

Practice Phone: 602-612-2305
Practice Fax:

Directions to “PORTABLE X RAY OF ARIZONA LLC ” Practice Location

Language	Start Address	Practice Location

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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.