Provider Demographics
NPI:1558665166
Name:PRI X-RAY, LLC
Entity Type:Organization
Organization Name:PRI X-RAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-932-8599
Mailing Address - Street 1:1000 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3475
Mailing Address - Country:US
Mailing Address - Phone:770-932-8599
Mailing Address - Fax:770-614-8048
Practice Address - Street 1:1000 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3475
Practice Address - Country:US
Practice Address - Phone:770-932-8599
Practice Address - Fax:770-614-8048
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRI X-RAY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier