MEDICARE: ALL-STAT PORTABLE IN 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	:	1720545296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL-STAT PORTABLE IN LLC

Provider Business Mailing Address
First Line	:	8235 CHRISTIANA AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-2910
Country	:	US
Telephone Number	:	224-337-1000
Fax Number	:	224-337-0100

Provider Business Practice Location Address
First Line	:	3201 STELLHORN RD STE A129
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4697
Country	:	US
Telephone Number	:	224-337-1401
Fax Number	:	224-337-0401

Authorized Official
Title or Position	:	CEO
Name	:	MR. ETAI SOOLIMAN
Credential	:
Telephone Number	:	224-337-1000

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	02/09/2023

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