MEDICARE: HOMESTEAD PORTABLE X-RAY 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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number	:	1346221611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMESTEAD PORTABLE X-RAY SERVICES INC

Provider Business Mailing Address
First Line	:	4700 NW 7TH ST
Second Line	:	SUITE 3
City	:	MIAMI
State	:	FL
Zip	:	33126-2252
Country	:	US
Telephone Number	:	786-866-9737
Fax Number	:	786-866-5933

Provider Business Practice Location Address
First Line	:	4700 NW 7TH ST
Second Line	:	SUITE 3
City	:	MIAMI
State	:	FL
Zip	:	33126-2252
Country	:	US
Telephone Number	:	786-866-9737
Fax Number	:	786-866-5933

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KAADIR HERRERA ORTEGA
Credential	:
Telephone Number	:	786-866-9737

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	08/09/2010

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