Provider Demographics
NPI:1891495743
Name:UNITED PORTABLE DIAGNOSTIC IMAGING INC
Entity Type:Organization
Organization Name:UNITED PORTABLE DIAGNOSTIC IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSAPHAT
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:561-818-6479
Mailing Address - Street 1:202 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2960
Mailing Address - Country:US
Mailing Address - Phone:561-818-6479
Mailing Address - Fax:
Practice Address - Street 1:202 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2960
Practice Address - Country:US
Practice Address - Phone:561-818-6479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)