1518917707 NPI number — MIDTOWN IMAGING LLC

Table of content: (NPI 1518917707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518917707 NPI number — MIDTOWN IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDTOWN IMAGING 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:
1518917707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5405 OKEECHOBEE BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33417-4543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-697-3001
Provider Business Mailing Address Fax Number:
561-697-3284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5405 OKEECHOBEE BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33417-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-697-3001
Provider Business Practice Location Address Fax Number:
561-697-3284
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHEIF FINANCIAL OFFICER
Authorized Official Telephone Number:
561-697-3001

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  JR3001900 , 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: V2692 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 16566 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2966 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 100393 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 80771 . This is a "PRINCIPAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 13131 . This is a "FOUNDATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0853314 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2448 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2965 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1600555 . This is a "UNITED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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