Provider Demographics
NPI:1437102480
Name:PUTNAM XRAY CENTER INC
Entity Type:Organization
Organization Name:PUTNAM XRAY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-782-1065
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93258-1866
Mailing Address - Country:US
Mailing Address - Phone:559-782-1065
Mailing Address - Fax:
Practice Address - Street 1:1521 N BEVERLY ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1065
Practice Address - Country:US
Practice Address - Phone:559-782-1065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16426ZMedicare ID - Type UnspecifiedGROUP NUMBER