Organization
RUSSELL L. PALMER JR, R.T., B.S.
Active
Other names
Alliance Mobile X-ray
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL LEON PALMER JR. R.T.,B.S. (OWNER)
(928) 777-9064
Entity
Organization
Contact information
Practice address
214 WHITE SPAR RD, PRESCOTT, AZ 86303-4236
(928) 777-9064
(928) 777-9183
Mailing address
1045 SCOTT DR, PRESCOTT, AZ 86301-1731
(928) 777-9064
(928) 777-9183
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
CRT-5873
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0722380
BLUECROSS/BLUESHIELD I.D.
AZ
01
—
630001733
RAILROAD MEDICARE NUMBER
AZ
Enumeration date
04/17/2006
Last updated
06/16/2008
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