1922349497 NPI number — PROFESSIONAL DIAGNOSTICS READING

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 1922349497 NPI number — PROFESSIONAL DIAGNOSTICS READING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL DIAGNOSTICS READING
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:
1922349497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4100 N POWERLINE RD
Provider Second Line Business Mailing Address:
STE G2
Provider Business Mailing Address City Name:
POMPANO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33073-3083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-828-5999
Provider Business Mailing Address Fax Number:
954-858-5354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 N POWERLINE RD
Provider Second Line Business Practice Location Address:
STE G2
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33073-3083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-828-5999
Provider Business Practice Location Address Fax Number:
954-858-5354
Provider Enumeration Date:
03/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MOTHERSIL
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
561-616-9095

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com