1629073234 NPI number — MRI RADIOLOGY NETWORK PA

Table of content: (NPI 1629073234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629073234 NPI number — MRI RADIOLOGY NETWORK PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MRI RADIOLOGY NETWORK PA
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:
UNIVERSITY MRI WEST
Provider Other Organization Name Type Code:
3
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:
1629073234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3848 FAU BLVD., SUITE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33431-6437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-362-9191
Provider Business Mailing Address Fax Number:
561-394-5674

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22059 STATE ROAD 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33428-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-362-9191
Provider Business Practice Location Address Fax Number:
561-394-5674
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STEINBERG
Authorized Official First Name:
FRED
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-362-9191

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  ME56655 , 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: 25639502 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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