Provider Demographics
NPI:1720545296
Name:ALL-STAT PORTABLE IN LLC
Entity Type:Organization
Organization Name:ALL-STAT PORTABLE IN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ETAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-337-1000
Mailing Address - Street 1:8235 CHRISTIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2910
Mailing Address - Country:US
Mailing Address - Phone:224-337-1000
Mailing Address - Fax:224-337-0100
Practice Address - Street 1:3201 STELLHORN RD STE A129
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-4697
Practice Address - Country:US
Practice Address - Phone:224-337-1401
Practice Address - Fax:224-337-0401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALL-STAT PORTABLE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-21
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier