Organization
PORTABLE X-RAY OF UTAH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABBY GROSSA (CFO)
(702) 395-5011
Entity
Organization
Contact information
Practice address
2212 S WEST TEMPLE, SALT LAKE CITY, UT 84115-2642
(801) 359-2532
(801) 485-4174
Mailing address
5538 DUNCAN DR, LAS VEGAS, NV 89130-2812
(702) 645-2606
(702) 645-2874
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80990680000001
BLUE CROSS BLUE SHIELD
UT
01
—
IDX10887
HEALTHY U MEDICAID
UT
Enumeration date
07/30/2006
Last updated
04/20/2008
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