Organization
PORTABLE IMAGING OF ARIZONA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABBY GROSSA (CFO)
(702) 939-6559
Entity
Organization
Contact information
Practice address
2338 W ROYAL PALM RD, SUITE A, PHOENIX, AZ 85021-9339
(602) 864-3656
(602) 864-3660
Mailing address
5538 DUNCAN DR, LAS VEGAS, NV 89130-2812
(702) 939-6559
(702) 939-6570
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
389820
AHCCES
AZ
01
—
389820
HEALTHCHOICE
—
05
—
389820
—
AZ
Enumeration date
09/23/2008
Last updated
03/12/2009
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