Provider Demographics
NPI:1144583543
Name:PORTABLE IMAGING OF NEVADA LLC
Entity Type:Organization
Organization Name:PORTABLE IMAGING OF NEVADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBE
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-525-1778
Mailing Address - Street 1:3675 PECOS MCLEOD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3815
Mailing Address - Country:US
Mailing Address - Phone:702-836-9232
Mailing Address - Fax:702-836-9555
Practice Address - Street 1:3675 PECOS MCLEOD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3815
Practice Address - Country:US
Practice Address - Phone:702-836-9232
Practice Address - Fax:702-836-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile