Provider Demographics
NPI:1063742211
Name:VERIZON PORTABLE XRAY SERVICE INC.
Entity type:Organization
Organization Name:VERIZON PORTABLE XRAY SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIC TECHNOLOGIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:OTT
Authorized Official - Suffix:I
Authorized Official - Credentials:RTR
Authorized Official - Phone:806-240-0965
Mailing Address - Street 1:350 FM 145
Mailing Address - Street 2:
Mailing Address - City:EARTH
Mailing Address - State:TX
Mailing Address - Zip Code:79031-2110
Mailing Address - Country:US
Mailing Address - Phone:806-240-0965
Mailing Address - Fax:
Practice Address - Street 1:350 FM 145
Practice Address - Street 2:
Practice Address - City:EARTH
Practice Address - State:TX
Practice Address - Zip Code:79031-2110
Practice Address - Country:US
Practice Address - Phone:806-240-0965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health