MEDICARE: PORTABLE DIAGNOSTIC 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	2085R0202X	Diagnostic Radiology Physician	K9889	TX

General Provider Information

NPI Number	:	1649337965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTABLE DIAGNOSTIC SERVICES INC.

Provider Business Mailing Address
First Line	:	PO BOX 740732
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75374-0732
Country	:	US
Telephone Number	:	214-368-0101
Fax Number	:	972-613-0546

Provider Business Practice Location Address
First Line	:	3022 MOTLEY DR STE 100
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150-3440
Country	:	US
Telephone Number	:	214-368-0101
Fax Number	:	972-613-0546

Authorized Official
Title or Position	:	OPERATION DIRECTOR-OWNER
Name	:	MR. VARGHESE RAJU
Credential	:	M.A.B.ED.
Telephone Number	:	214-368-0101

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/22/2020

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