Organization
PORTA-MED, INC.
Active
Other names
Porta-Med
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD B BALLAH JR. (EXECUTIVE DIRECTOR)
(419) 663-1367
Entity
Organization
Contact information
Practice address
12513 US HIGHWAY 250 N, MILAN, OH 44846-9546
(800) 589-2515
(419) 499-2664
Mailing address
12513 US HIGHWAY 250 N, MILAN, OH 44846-9546
(800) 589-2515
(419) 499-2664
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000287994
ANTHEM BLUE CROSS
OH
05
—
0416133
—
OH
01
—
1275060
UNITED MINE WORKERS
—
Enumeration date
08/17/2005
Last updated
08/27/2007
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