Provider Demographics
NPI:1649337965
Name:PORTABLE DIAGNOSTIC SERVICES INC.
Entity type:Organization
Organization Name:PORTABLE DIAGNOSTIC SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION DIRECTOR-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VARGHESE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MABED
Authorized Official - Phone:214-368-0101
Mailing Address - Street 1:PO BOX 740732
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-0732
Mailing Address - Country:US
Mailing Address - Phone:214-368-0101
Mailing Address - Fax:972-613-0546
Practice Address - Street 1:3022 MOTLEY DR STE 100
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3440
Practice Address - Country:US
Practice Address - Phone:214-368-0101
Practice Address - Fax:972-613-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK98892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459852Medicare ID - Type UnspecifiedPORTABLE X-RAY PROVIDER