Portable Medical Diagnostics LLC
Organization Active NPI Portable X-ray and/or Other Portable Diagnostic Imaging Supplier · Irvington, AL
NPI 1326384306 · NPPES record last updated Feb 7, 2013
Key facts
- NPI
- 1326384306
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X
- Legal business name
- PORTABLE MEDICAL DIAGNOSTICS LLC
- Practice address
- 9047 Home Ave
Irvington, AL 36544-2855 - Phone
- (251) 272-1080
- Fax
- (251) 272-1080
- NPI assigned
- Dec 20, 2012
- Organization subpart
- No
Authorized official
- Name
- Douglas Brown
- Title
- Managing Member
- Phone
- (601) 987-9729
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130405000011 | AL | Part B Supplier - Portable X-Ray Supplier | 1052585049 | Practice locations: Irvington, AL |
National Provider Directory
- Tax ID family
- Portable Medical Diagnostics LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 335V00000X | AL | Yes |
Addresses
Primary practice location
9047 Home Ave
Irvington, AL 36544-2855
Mailing address
1855 Lakeland Dr
Suite G10
Jackson, MS 39216-4913
Phone (601) 987-9729
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9074 | Other | AL | STATE BOARD OF HEALTH IPL LICENSE |
Other providers in Irvington, AL
- Lisa Wright Parnell
- Rubesh Patel
- Michael A Pickert
- Bonnie Diane Pickett
- Laurie Kathryn Plosczynski
- Portable Medical Diagnostics LLC
- Baylee D Porter
- Wilsania L. Rodriguez Mendez
- Wendy Smith
- Maranda Sotile
All providers in Irvington, AL · Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.