Provider Demographics
NPI:1003182056
Name:NATIONAL IMAGING AND URGENT CARE, INC.
Entity Type:Organization
Organization Name:NATIONAL IMAGING AND URGENT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:TYNDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-915-3028
Mailing Address - Street 1:3601 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3300
Mailing Address - Country:US
Mailing Address - Phone:954-915-3028
Mailing Address - Fax:954-714-6078
Practice Address - Street 1:3601 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 20
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3300
Practice Address - Country:US
Practice Address - Phone:954-915-3028
Practice Address - Fax:954-714-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84420207R00000X, 261QU0200X
FLPT27280208100000X
261QM1200X
FLARNP2810312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME037878OtherMEDICAL LICENSE
FLPT27280OtherMEDICAL LICENSE
FLARNP2810312OtherMEDICAL LICENSE
FLME84420OtherMEDICAL LICENSE