Portable X Ray of Arizona LLC

Primary specialty

Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X

Legal business name

PORTABLE X RAY OF ARIZONA LLC

Practice address

2338 West Royal Palm Drive
Phoenix, AZ 85021

Phone

(602) 864-3656

Fax

(602) 864-3660

NPI assigned

Oct 3, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Abby Grossa

Title

Cfo

Phone

(702) 395-5011

Specialties & licenses 1

Addresses

Other identifiers 8

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1336234772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5538 WEST DUNCAN DRIVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89130",
            "telephone_number": "702-395-5011",
            "fax_number": "702-645-2874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2338 WEST ROYAL PALM DRIVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85021",
            "telephone_number": "602-864-3656",
            "fax_number": "602-864-3660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTABLE X RAY OF ARIZONA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "GROSSA",
        "authorized_official_first_name": "ABBY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "702-395-5011"
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "2Z1598",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHCHOICE",
            "identifier": "579055",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "579055",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "AW2888",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BULE CROSS BLUE SHIELD OF",
            "identifier": "AZ0890990",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "579055",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SCAN",
            "identifier": "65945",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHOENIX HEALTH PLAN",
            "identifier": "F10081",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keith J Porche, MD
• Enriqueta M Porras, M.D.
• Misael Porras
• Vanessa Porras, FNP-C
• Portable Imaging of Arizona, LLC
• Portable X Ray of Arizona LLC
• Portable Xray of Arizona Phoenix
• Breanna Portale
• Melissa Portela, A.T.
• Victoria Porten

• Mobile Radiology Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Mobile Radiology Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.