1871584771 NPI number — PALMS WEST MRI, LLC

Table of content: (NPI 1871584771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871584771 NPI number — PALMS WEST MRI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALMS WEST MRI, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871584771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 212738
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROYAL PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33421-2738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-766-1300
Provider Business Mailing Address Fax Number:
561-318-7163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLE GLADE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33430-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-996-2000
Provider Business Practice Location Address Fax Number:
561-996-2008
Provider Enumeration Date:
10/31/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HANSEN
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
561-766-1300

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  HCC8896 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002891000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: V2507 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 017983100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".