Provider Demographics
NPI:1104225531
Name:ALLIED PORTABLE X-RAY INC
Entity type:Organization
Organization Name:ALLIED PORTABLE X-RAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:STIEGLITZ-LEATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-364-6243
Mailing Address - Street 1:1255 FILER AVE E STE C
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4118
Mailing Address - Country:US
Mailing Address - Phone:855-364-6243
Mailing Address - Fax:855-463-3211
Practice Address - Street 1:1255 FILER AVE E STE C
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4118
Practice Address - Country:US
Practice Address - Phone:855-364-6243
Practice Address - Fax:855-463-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN435970261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1104225531Medicaid