1174849103 NPI number — INMED DIAGNOSTIC SERVICES OF FLORIDA LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174849103 NPI number — INMED DIAGNOSTIC SERVICES OF FLORIDA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INMED DIAGNOSTIC SERVICES OF FLORIDA 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:
1174849103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 E COMMERCIAL BLVD
Provider Second Line Business Mailing Address:
SUITE 826
Provider Business Mailing Address City Name:
FT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33308-4054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-510-3700
Provider Business Mailing Address Fax Number:
954-510-2649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8110 ROYAL PALM BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33065-5795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-341-4200
Provider Business Practice Location Address Fax Number:
954-341-5360
Provider Enumeration Date:
04/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LONGTON
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
954-510-3704

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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