Basic Information
| Provider Information | |||||||||
| NPI: | 1144583543 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PORTABLE IMAGING OF NEVADA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3675 PECOS MCLEOD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891213815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028369232 | ||||||||
| FaxNumber: | 7028369555 | ||||||||
| Practice Location | |||||||||
| Address1: | 3675 PECOS MCLEOD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891213815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028369232 | ||||||||
| FaxNumber: | 7028369555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2012 | ||||||||
| LastUpdateDate: | 06/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | MONKS | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBE | ||||||||
| AuthorizedOfficialTelephone: | 7025251778 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0208X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mobile |
No ID Information.