Provider Demographics
NPI:1558508556
Name:PORTABLE MEDICAL DIAGNOSTICS
Entity Type:Organization
Organization Name:PORTABLE MEDICAL DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROSEBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-964-7984
Mailing Address - Street 1:840 US HIGHWAY ONE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3833
Mailing Address - Country:US
Mailing Address - Phone:561-626-9021
Mailing Address - Fax:561-626-7593
Practice Address - Street 1:1855 LAKELAND DRIVE
Practice Address - Street 2:SUITE G10
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4926
Practice Address - Country:US
Practice Address - Phone:601-987-9425
Practice Address - Fax:601-987-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMRT19712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty