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.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Portable Xray Supplier |
335V00000X | 63 | Portable X-Ray Supplier | |
Sonography Radiologic Technologist |
2471S1302X | |||
Specialist/Technologist Cardiovascular, Sonography |
246XS1301X | |||
Vascular Sonography Radiologic Technologist |
2471V0105X |
| NPI Number | 1598063133 |
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| LBN Legal business name | SOURCE DIAGNOSTICS WEST LLC | ||||
| Authorized official | PAUL MEZACAPA - (MANAGING MEMBER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 03/07/2011 | ||||
| Last updated | 05/18/2011 - About 15 years ago | ||||
| Identifiers |
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