1578526414 NPI number — PALM BEACH EFL IMAGING CENTER 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 1578526414 NPI number — PALM BEACH EFL IMAGING CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALM BEACH EFL IMAGING CENTER 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:
6
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:
1578526414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 N FLAGLER DR
Provider Second Line Business Mailing Address:
SUITE 720
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33401-3428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-838-3600
Provider Business Mailing Address Fax Number:
561-804-9949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 N FLAGLER DR
Provider Second Line Business Practice Location Address:
SUITE 720
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:
33401-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-838-3618
Provider Business Practice Location Address Fax Number:
561-804-3594
Provider Enumeration Date:
04/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAWSON
Authorized Official First Name:
GARTH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATIONS OFFICER
Authorized Official Telephone Number:
561-838-3630

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: 272379400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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