1194887539 NPI number — PALM BEACH RADIOLOGY AND IMAGING ASSOCIATES

Table of content: (NPI 1194887539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194887539 NPI number — PALM BEACH RADIOLOGY AND IMAGING ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALM BEACH RADIOLOGY AND IMAGING ASSOCIATES
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:
1194887539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
733 US HIGHWAY 1 BLDG 2B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33408-4513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-841-8588
Provider Business Mailing Address Fax Number:
561-841-8533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
733 US HIGHWAY 1 BLDG 2B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33408-4513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-841-8588
Provider Business Practice Location Address Fax Number:
561-841-8533
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALTON
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE DEPARTMENT
Authorized Official Telephone Number:
561-841-8588

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  200720481 , 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: N272625 . This is a "HEALTHEASE HEALTHPLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N272625 . This is a "SOUTH FLORIDA REGION HEAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 377844400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33933 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N272625 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N272625 . This is a "STAYWELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 377844400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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