NPIMap

Organization Active NPI

Portable Medical Diagnostics LLC

  • Physiological Laboratory
  • Irvington, AL
National Provider Identifier
1730425547
Registry record updated Jul 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
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 26, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2014

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

Authorized official

Name
Douglas Brown
Title
Managing Member
Phone
(601) 987-9729

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X Primary

Addresses

Primary practice location

9047 Home Ave
Irvington, AL 36544-2855

Mailing address

1855 Lakeland Dr
Ste G10
Jackson, MS 39216-4913
Phone (601) 987-9729

Other identifiers 1

IdentifierTypeStateIssuer
9074OtherALSTATE BOARD OF HEALTH IPL LICENSE

National Provider Directory

National Provider Directory
Tax ID family
Portable Medical Diagnostics LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1356480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405900800000",
    "number": "1730425547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 LAKELAND DR",
            "address_2": "STE G10",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164913",
            "telephone_number": "601-987-9729",
            "fax_number": "601-987-0093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9047 HOME AVE",
            "city": "IRVINGTON",
            "state": "AL",
            "postal_code": "365442855",
            "telephone_number": "251-272-1080",
            "fax_number": "251-272-1080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTABLE MEDICAL DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-26",
        "last_updated": "2014-07-21",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "601-987-9729"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF HEALTH IPL LICENSE",
            "identifier": "9074",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvington, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; 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.