Organization
PORTABLE X RAY OF SOUTHERN NEVADA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABBY GROSSA (CFO)
(702) 939-6559
Entity
Organization
Contact information
Practice address
5488 DUNCAN DR, LAS VEGAS, NV 89130-2812
(702) 655-0535
(702) 655-0538
Mailing address
5538 DUNCAN DR, LAS VEGAS, NV 89130-2812
(702) 645-2606
(702) 645-1478
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NV3524
NV BLUE SHIELD
NV
Enumeration date
01/09/2006
Last updated
04/20/2008
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