MEDICARE: PRIMEX PORTABLE 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	2471C3402X	Radiography Radiologic Technologist

General Provider Information

NPI Number	:	1760244784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMEX PORTABLE LLC

Provider Business Mailing Address
First Line	:	6045 75TH ST # 1
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-5223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6045 75TH ST # 1
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-5223
Country	:	US
Telephone Number	:	347-335-3151
Fax Number	:

Authorized Official
Title or Position	:	AGENT
Name	:	MR. BRIAN HURTADO
Credential	:
Telephone Number	:	347-335-3151

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	01/25/2024

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Directions to “PRIMEX PORTABLE LLC ” Practice Location

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