# NOVA PORTABLE XRAY LLC

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

## Provider details

- **NPI number:** 1891402293
- **Authorized official:** OMAR KHASAWINAH (ADMINISTRATOR)
- **Authorized official phone:** (573) 239-6116

## Contact information

- **Practice address:** 4020 DAVID LN, ALEXANDRIA, VA 22311-1111
- **Practice address phone:** (573) 239-6116
- **Mailing address:** 4020 DAVID LN, ALEXANDRIA, VA 22311-1111
- **Mailing address phone:** (573) 239-6116

## Taxonomy

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

## Other

- **Enumeration date:** 11/04/2022
- **Last updated:** 10/28/2025