Provider Demographics
NPI:1003429887
Name:DAV-KIM PORTABLE X RAY SERVICE CO
Entity Type:Organization
Organization Name:DAV-KIM PORTABLE X RAY SERVICE CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ETAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-337-1000
Mailing Address - Street 1:8235 CHRISTIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2910
Mailing Address - Country:US
Mailing Address - Phone:224-337-1000
Mailing Address - Fax:224-337-0100
Practice Address - Street 1:8235 CHRISTIANA AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2910
Practice Address - Country:US
Practice Address - Phone:224-337-1000
Practice Address - Fax:224-337-0100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALL-STAT PORTABLE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile