Provider Demographics
NPI:1326421363
Name:MEDI-RAY PORTABLE, INC
Entity Type:Organization
Organization Name:MEDI-RAY PORTABLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIV
Authorized Official - Middle Name:R
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-594-0780
Mailing Address - Street 1:7132 N HARLEM AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1086
Mailing Address - Country:US
Mailing Address - Phone:773-594-0780
Mailing Address - Fax:773-945-6742
Practice Address - Street 1:7132 N HARLEM AVE STE 104
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1086
Practice Address - Country:US
Practice Address - Phone:773-594-0780
Practice Address - Fax:773-945-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209859261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile