1114250453 NPI number — FLORIDA RADIOLOGY SPECIALISTS, P.L.

Table of content: (NPI 1114250453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114250453 NPI number — FLORIDA RADIOLOGY SPECIALISTS, P.L.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA RADIOLOGY SPECIALISTS, P.L.
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:
1114250453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 KNUTH RD
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33436-4693
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-736-1200
Provider Business Mailing Address Fax Number:
561-742-1919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 EVENTIDE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34994-9143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-736-1200
Provider Business Practice Location Address Fax Number:
561-742-1919
Provider Enumeration Date:
09/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CHARLES
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
561-736-1200

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0026694-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DQ7718 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 001LK . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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