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Russell L. Palmer Jr, R.t., B.s.
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Prescott, Arizona
NPI 1245295021

Russell L. Palmer Jr, R.t., B.s. is a Portable X-ray and/or Other Portable Diagnostic Imaging Supplier based in Prescott, AZ. Russell L. Palmer Jr, R.t., B.s. practices in Prescott, AZ. The NPI Number for Russell L. Palmer Jr, R.t., B.s. is 1245295021 and holds a License No. CRT-5873 (Arizona).

The current practice location address for Russell L. Palmer Jr, R.t., B.s. is 214 White Spar Rd, Prescott, AZ and can be reached out via phone at 928-777-9064 and via fax at 928-777-9183.

Location: 214 White Spar Rd, Prescott, AZ, 86301-1731
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1245295021
Provider Name
Russell L. Palmer Jr, R.t., B.s.
Credential
Provider Entity Type
Organization
Address
214 White Spar Rd, Prescott, AZ, 86301-1731
Phone Number
928-777-9064
Fax Number
928-777-9183
Provider Enumeration Date
04/17/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
630001733 01 AZ RAILROAD MEDICARE NUMBER
0722380 01 AZ BLUECROSS/BLUESHIELD I.D.
institution
Provider Business Practice Location Address Details
Address
214 White Spar Rd
City
Prescott
State
Arizona
Zip
86303-4236
Phone Number
928-777-9064
Fax Number
928-777-9183
person
Provider Business Mailing Address Details
Address
214 White Spar Rd
City
Prescott
State
Arizona
Zip
86303-4236
Phone Number
928-777-9064
Fax Number
928-777-9183
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Speciality
-
Taxonomy
335V00000X
License No.
CRT-5873 (Arizona)
Definition
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.
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