1952404519 NPI number — PALM BEACH BROWARD MEDICAL IMAGING CENTER, INC.

Table of content: (NPI 1952404519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952404519 NPI number — PALM BEACH BROWARD MEDICAL IMAGING CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALM BEACH BROWARD MEDICAL IMAGING CENTER, 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:
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:
1952404519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 E HILLSBORO BLVD
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
DEERFIELD BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33441-4356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-426-3006
Provider Business Mailing Address Fax Number:
954-481-9318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 E HILLSBORO BLVD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
DEERFIELD BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33441-4356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-426-3006
Provider Business Practice Location Address Fax Number:
954-481-9318
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLAK
Authorized Official First Name:
KAYA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MEDICAL DIRECTOR
Authorized Official Telephone Number:
954-426-3006

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  HCC3645 , 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: 05357A2 . This is a "CAREPLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 707585 . This is a "WELLCARE STAYWELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N1551 . This is a "HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: SG017032 . This is a "VISTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 065032300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300022828 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: AN30474120001 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2998 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2240778 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0032120 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 003400 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3400023 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010119800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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