| Name | Value |
|---|---|
| PROVIDER TYPE | Suppliers |
| CLASSIFICATION | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| 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. |
| STATUS | Active |
| X12 CODE | 335V00000X |
| SPECIALTY CODE | 63 |
| INDIVIDUAL/NON | NON-INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5255552 |
| EFFECTIVE DATE/TIME |
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