Provider Demographics
NPI:1497942973
Name:X RAY EXPRESS LLP
Entity Type:Organization
Organization Name:X RAY EXPRESS LLP
Other - Org Name:X RAY EXPRESS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PERRETT
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT RT
Authorized Official - Phone:605-391-0005
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-0948
Mailing Address - Country:US
Mailing Address - Phone:605-391-0005
Mailing Address - Fax:
Practice Address - Street 1:6920 MERION CT
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702
Practice Address - Country:US
Practice Address - Phone:605-391-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD49784335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS40743Medicare PIN