# COMMUNITY PORTABLE X-RAY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396850632
- **Authorized official:** MR. JASON ROEDER (CFO)
- **Authorized official phone:** (303) 371-0073

## Contact information

- **Practice address:** 1635 DORCHESTER DR, PLANO, TX 75075-6443
- **Practice address phone:** (972) 633-9427
- **Practice address fax:** (972) 881-1250
- **Mailing address:** PO BOX 39931, DENVER, CO 80239-0931
- **Mailing address phone:** (303) 371-0073
- **Mailing address fax:** (303) 576-7986

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 293D00000X | Physiological Laboratory | — | NULL | — |
| 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 08/19/2006
- **Last updated:** 02/12/2016