Provider Demographics
NPI:1619204203
Name:PIONEER MEDICAL PORTABLE XRAY,LLC
Entity Type:Organization
Organization Name:PIONEER MEDICAL PORTABLE XRAY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:H
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RT
Authorized Official - Phone:601-550-4611
Mailing Address - Street 1:100 CLARENDON AVE
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-2636
Mailing Address - Country:US
Mailing Address - Phone:601-550-4611
Mailing Address - Fax:601-510-9449
Practice Address - Street 1:100 CLARENDON AVE
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-2636
Practice Address - Country:US
Practice Address - Phone:601-550-4611
Practice Address - Fax:601-510-9449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIONEER MEDICAL, IDTF
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-03
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier