Provider Demographics
NPI:1427737063
Name:PORTABLE X-RAY ON DEMAND LLC
Entity type:Organization
Organization Name:PORTABLE X-RAY ON DEMAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:RODRIGUE
Authorized Official - Last Name:BITKEU BONGNI
Authorized Official - Suffix:
Authorized Official - Credentials:RADIOLOGIST TECH
Authorized Official - Phone:124-059-5540
Mailing Address - Street 1:8001 MANDAN RD APT 102
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2849
Mailing Address - Country:US
Mailing Address - Phone:240-595-5407
Mailing Address - Fax:
Practice Address - Street 1:8001 MANDAN RD APT 102
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2849
Practice Address - Country:US
Practice Address - Phone:124-059-5540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier