Provider Demographics
NPI:1457433526
Name:ADVANCED PORTABLE X-RAY
Entity type:Organization
Organization Name:ADVANCED PORTABLE X-RAY
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 1:3718 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-2244
Practice Address - Country:US
Practice Address - Phone:224-337-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR27937247100000X
335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150549710Medicaid
AR19821Medicare ID - Type Unspecified
AR150549710Medicaid