Organization
PORTABLE RADIOLOGY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICOLE LYNN OLEAR R.T. (OWNER)
(330) 433-0465
Entity
Organization
Contact information
Practice address
8948 KENNEMER CIR NW, NORTH CANTON, OH 44720-8237
(330) 433-0465
(330) 433-0466
Mailing address
8948 KENNEMER CIR NW, NORTH CANTON, OH 44720-8237
(330) 433-0465
(330) 433-0466
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000376207
ANTHEM
OH
01
—
16-02180
EVERCARE
OH
05
—
2599880
—
OH
01
—
A9999
HOMETOWN
OH
01
—
P00235222
RAILROAD MEDICARE
OH
Enumeration date
02/21/2007
Last updated
08/22/2020
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