Organization
COMMUNITY PORTABLE X-RAY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON ROEDER (CFO)
(303) 371-0073
Entity
Organization
Contact information
Practice address
1635 DORCHESTER DR, PLANO, TX 75075-6443
(972) 633-9427
(972) 881-1250
Mailing address
PO BOX 39931, DENVER, CO 80239-0931
(303) 371-0073
(303) 576-7986
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
—
—
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143330202
—
TX
Enumeration date
08/19/2006
Last updated
02/12/2016
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