1437433935 NPI number — PROFESSIONAL DIAGNOSTIC READING MRI INC

Table of content: (NPI 1437433935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437433935 NPI number — PROFESSIONAL DIAGNOSTIC READING MRI INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL DIAGNOSTIC READING MRI INC
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:
1437433935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 N MILITARY TRL
Provider Second Line Business Mailing Address:
STE 108
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33409-2951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-616-9095
Provider Business Mailing Address Fax Number:
561-616-9094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 N MILITARY TRL
Provider Second Line Business Practice Location Address:
STE 108
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:
33409-2951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-616-9095
Provider Business Practice Location Address Fax Number:
561-616-9094
Provider Enumeration Date:
10/03/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TUREK
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
900-400-5752

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  ME91047 , 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: HCC 9391 . This is a "AHCA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".