MEDICARE: PROFESSIONAL PORTABLE RADIOLOGIC 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	:	1740867712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL PORTABLE RADIOLOGIC SERVICES INC.

Provider Business Mailing Address
First Line	:	755 CLIFF RD E
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1545
Country	:	US
Telephone Number	:	866-895-2119
Fax Number	:	952-890-9025

Provider Business Practice Location Address
First Line	:	720 CARNEGIE DR STE 140
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3516
Country	:	US
Telephone Number	:	866-895-2119
Fax Number	:	952-890-9025

Authorized Official
Title or Position	:	VP-AO
Name	:	BRUCE ALLEN JOHNSON
Credential	:
Telephone Number	:	303-589-4149

Provider Enumeration Date	:	03/25/2021
Last Update Date	:	03/31/2025

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