All-Stat Portable in LLC
Organization Active NPI Portable X-ray and/or Other Portable Diagnostic Imaging Supplier · Fort Wayne, IN
NPI 1720545296 · NPPES record last updated Feb 9, 2023
Key facts
- NPI
- 1720545296
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X
- Legal business name
- ALL-STAT PORTABLE IN LLC
- Practice address
- 3201 Stellhorn Rd Ste A129
Fort Wayne, IN 46815-4697 - Phone
- (224) 337-1401
- Fax
- (224) 337-0401
- NPI assigned
- Feb 21, 2019
- Organization subpart
- Yes
- Parent organization (as reported)
- ALL-STAT PORTABLE, LLC
Authorized official
- Name
- Mr. Etai Sooliman
- Title
- Ceo
- Phone
- (224) 337-1000
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 10
-
Adel Abdalla, M.D.
-
Maximina Boutselis, M.D.
-
Frank R Graybeal Jr., M. D.
-
Curt E Liebman, M.D.
-
Ranjiv Kumar Saini, M.D.
-
Pradheep J Shanker, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190731000494 | IN | Part B Supplier - Portable X-Ray Supplier | 1254667165 | Practice locations: Fort Wayne, IN |
National Provider Directory
- Tax ID family
- All-Stat Portable in LLC
Locations
3201 Stellhorn Rd
Ste A129
Fort Wayne, IN 46815
Phone (224) 337-1000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 335V00000X | Yes |
Addresses
Primary practice location
3201 Stellhorn Rd Ste A129
Fort Wayne, IN 46815-4697
Mailing address
8235 Christiana Ave
Skokie, IL 60076-2910
Phone (224) 337-1000
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All providers in Fort Wayne, IN · Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2023. 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.