Provider Demographics
NPI:1497942478
Name:CONTINENTAL PORTABLE X-RAY SERVICE
Entity type:Organization
Organization Name:CONTINENTAL PORTABLE X-RAY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TEOFILA
Authorized Official - Middle Name:GONZALES
Authorized Official - Last Name:MESINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-622-1600
Mailing Address - Street 1:6016 W BARRY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5105
Mailing Address - Country:US
Mailing Address - Phone:773-818-6775
Mailing Address - Fax:773-622-8608
Practice Address - Street 1:6016 W BARRY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5105
Practice Address - Country:US
Practice Address - Phone:773-818-6775
Practice Address - Fax:773-622-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL149846Medicare PIN