Provider Demographics
NPI:1619368834
Name:PORTABLE MEDICAL RESOURCES LTD
Entity Type:Organization
Organization Name:PORTABLE MEDICAL RESOURCES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-397-5554
Mailing Address - Street 1:129 PHELPS AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2453
Mailing Address - Country:US
Mailing Address - Phone:815-397-5554
Mailing Address - Fax:815-550-0061
Practice Address - Street 1:129 PHELPS AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2453
Practice Address - Country:US
Practice Address - Phone:815-397-5554
Practice Address - Fax:815-550-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Multi-Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty