MEDICARE: COLMED LABORATORIES & RADIOLOGY, 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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number	:	1578972790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLMED LABORATORIES & RADIOLOGY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2135
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85244-2135
Country	:	US
Telephone Number	:	602-499-2672
Fax Number	:

Provider Business Practice Location Address
First Line	:	6392 MCLEOD DR STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4417
Country	:	US
Telephone Number	:	602-317-6103
Fax Number	:	602-454-9322

Authorized Official
Title or Position	:	CEO
Name	:	SAMUEL AKERS
Credential	:
Telephone Number	:	602-499-2672

Provider Enumeration Date	:	08/13/2014
Last Update Date	:	06/21/2020

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