METRO PORTABLE X-RAY SERVICE , NPI 1760697775 — CHICAGO (IL)

NPI 1760697775

12+ Years Experience Organization

METRO PORTABLE X-RAY SERVICE

05.12.2007
PROVIDER ENUMERATION DATE
07.08.2007
LAST UPDATE DATE
1760697775
NPI NUMBER

About METRO PORTABLE X-RAY SERVICE

METRO PORTABLE X-RAY SERVICE is a provider established in CHICAGO, IL. The NPI number of METRO PORTABLE X-RAY SERVICE is 1760697775 and was assigned on 05.12.2007. The practitioners primary taxonomy code is: 335V00000X with license number: 4,20E+16 IL .

Mailing address

  • City: CHICAGO
  • State: IL
  • Postal code: 606302286
  • Phone: 7737361402
  • Fax: 7737361403
  • Address: 4955 N MILWAUKEE AVE
  • Address 2: SUITE 1

Primary Practice Address

  • Region : CHICAGO, IL
  • NPI : 1760697775
  • Phone : 7737361402
  • Fax : 7737361403
  • Postalcode : 606302286
  • Address : 4955 N MILWAUKEE AVE SUITE 1

Provider taxonomy - Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

  • Taxonomy code: 335V00000X
  • License number: 4,20E+16
  • License state: IL

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (Holter Monitor), bone densitometry, sonography, and other imaging services in accordance with all state and federal requirements, under the general supervision of a qualified physician. All necessary resources are transported to the patient"s location where the services are performed.

Contacts:

Click to Show Map
  • METRO PORTABLE X-RAY SERVICE
  • Address : 4955 N MILWAUKEE AVE SUITE 1
  • Region : CHICAGO, IL
  • NPI : 1760697775
  • Phone : 7737361402
  • Fax : 7737361403
  • Postalcode : 606302286

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 7737361402
  • Title or position : PRESIDENT
  • Credentials : MD

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address4955 N MILWAUKEE AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSUITE 1
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCHICAGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameIL
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code606302286
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number7737361402
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number7737361403
The fax number associated with the location address of the provider being identified.
NPI1760697775
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1335V00000X
A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (Holter Monitor), bone densitometry, sonography, and other imaging services in accordance with all state and federal requirements, under the general supervision of a qualified physician. All necessary resources are transported to the patient"s location where the services are performed.
Provider Enumeration Date05.12.2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.08.2007
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)METRO PORTABLE X-RAY SERVICE
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address4955 N MILWAUKEE AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressSUITE 1
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameCHICAGO
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameIL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code606302286
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number7737361402
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number7737361403
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Authorized Official Last NameEMMANUEL
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameMILROY
The first name of the authorized official
Authorized Official Middle NameS
The middle name of the authorized official
Authorized Official Title or PositionPRESIDENT
The title or position of the authorized official
Authorized Official Name Prefix TextDR.
Authorized Official Name Prefix Text
Authorized Official Credential TextMD
Authorized Official Credential Text
Authorized Official Telephone Number7737361402
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1335V00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (Holter Monitor), bone densitometry, sonography, and other imaging services in accordance with all state and federal requirements, under the general supervision of a qualified physician. All necessary resources are transported to the patient"s location where the services are performed.
Provider License Number 14,20E+16
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1IL
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
X

Share this page?