Pri X-Ray, L.L.C.

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

Legal business name

PRI X-RAY, L.L.C.

Practice address

3620 McGinnis Park Dr
Suite #1
Suwanee, GA 30024-7136

Phone

(770) 932-8599

Fax

(770) 614-8048

NPI assigned

Nov 15, 2005

Last updated

Apr 27, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Allen Trader

Title

Manager

Phone

(770) 932-8599

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598747628. Details of each certification follow.

• CCN 11X0009814 Portable X-ray supplier · Active · Name & address match · Details

Portable X-ray supplier certification: CCN 11X0009814

Legal name

PRI X-RAY, LLC

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Dec 13, 1994

Last certification

Jul 8, 2002

Ownership / control type

CORPORATION

Facility address

3620 McGinnis Park Drive, Suite #1
Suwanee, GA 30024

Locations

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

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303862400000",
    "number": "1598747628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 MCGINNIS PARK DR",
            "address_2": "SUITE #1",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300247136",
            "telephone_number": "770-932-8599",
            "fax_number": "770-614-8048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 MCGINNIS PARK DR",
            "address_2": "SUITE #1",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300247136",
            "telephone_number": "770-932-8599",
            "fax_number": "770-614-8048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRI X-RAY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-15",
        "last_updated": "2011-04-27",
        "status": "A",
        "authorized_official_last_name": "TRADER",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-932-8599",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "630001384",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00803822A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.