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Organization
PORTABLE X RAY OF ARIZONA LLC
Active
Organization
PORTABLE X RAY OF ARIZONA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABBY GROSSA (CFO)
(702) 395-5011
Entity
Organization
Contact information
Practice address
2338 WEST ROYAL PALM DRIVE, PHOENIX, AZ 85021
(602) 864-3656
(602) 864-3660
Mailing address
5538 WEST DUNCAN DRIVE, LAS VEGAS, NV 89130
(702) 395-5011
(702) 645-2874
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2Z1598
HEALTH NET
AZ
01
—
579055
HEALTHCHOICE
AZ
05
—
579055
—
AZ
01
—
65945
SCAN
AZ
01
—
AW2888
HEALTHNET
AZ
01
—
AZ0890990
BULE CROSS BLUE SHIELD OF
AZ
01
—
F10081
PHOENIX HEALTH PLAN
AZ
Enumeration date
10/03/2006
Last updated
04/20/2008
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