All-Stat Portable Mi LLC
Organization Active NPI Portable X-ray and/or Other Portable Diagnostic Imaging Supplier · Saint Joseph, MI
NPI 1881342863 · NPPES record last updated Apr 4, 2022
Key facts
- NPI
- 1881342863
- 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 MI LLC
- Practice address
- 515 Ship St Ste 209
Saint Joseph, MI 49085-1155 - Phone
- (224) 337-1203
- Fax
- (224) 337-1204
- NPI assigned
- Mar 17, 2022
- 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 8
-
Larry Braver, D.O.
-
Adel Abdalla, M.D.
-
Jeremy D Havas, D.O
-
Justin Hung Pham, M.D.
-
Pradheep J Shanker, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220930001358 | MI | Part B Supplier - Portable X-Ray Supplier | 6507242526 | Practice locations: Saint Joseph, MI |
National Provider Directory
- Tax ID family
- All-Stat Portable Mi LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 335V00000X | Yes |
Addresses
Primary practice location
515 Ship St Ste 209
Saint Joseph, MI 49085-1155
Mailing address
8235 Christiana Ave
Skokie, IL 60076-2910
Phone (224) 337-1000
Other providers in Saint Joseph, MI
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- All-Stat Portable Mi LLC
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- Lakisha Allen
- Robert M Allen
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All providers in Saint Joseph, MI · Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2022. 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.