Provider Demographics
NPI:1922087998
Name:PORTABLE X-RAY OF WASHINGTON LLC
Entity Type:Organization
Organization Name:PORTABLE X-RAY OF WASHINGTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOOMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-645-2606
Mailing Address - Street 1:5538 W DUNCAN DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130
Mailing Address - Country:US
Mailing Address - Phone:702-645-2606
Mailing Address - Fax:702-645-2874
Practice Address - Street 1:6925 216TH ST SW
Practice Address - Street 2:SUITE N
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:425-640-2600
Practice Address - Fax:425-640-2174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7112519Medicaid
WA=========OtherBLUE CROSS BLUE SHIELD
WA7112519Medicaid
WA7112519Medicaid