1518929702 NPI number — OPEN MAGNETIC IMAGING OF WEST BOCA

Table of content: (NPI 1518929702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518929702 NPI number — OPEN MAGNETIC IMAGING OF WEST BOCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN MAGNETIC IMAGING OF WEST BOCA
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:
1518929702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 N. COMMERCE PARKWAY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WESTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-888-6411
Provider Business Mailing Address Fax Number:
954-888-6414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20401 STATE ROAD 7
Provider Second Line Business Practice Location Address:
SUITE G-8
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-482-5559
Provider Business Practice Location Address Fax Number:
561-482-4417
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DENOUN
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
COMPTROLLER
Authorized Official Telephone Number:
954-343-4065

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  HCC3912 , 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)





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