Provider Demographics
NPI:1841283306
Name:PORTARAD LLC
Entity type:Organization
Organization Name:PORTARAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RTR
Authorized Official - Phone:859-585-8992
Mailing Address - Street 1:7460 CHASE LANE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40337-8979
Mailing Address - Country:US
Mailing Address - Phone:866-972-9626
Mailing Address - Fax:859-498-6007
Practice Address - Street 1:7460 CHASE LANE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:KY
Practice Address - Zip Code:40337-8979
Practice Address - Country:US
Practice Address - Phone:866-972-9626
Practice Address - Fax:859-498-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY720223335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY86000338Medicaid
KY7002801Medicare ID - Type Unspecified