Provider Demographics
NPI:1023555794
Name:WOMEN'S DIAGNOSTIC CENTER OF BETHESDA INC
Entity Type:Organization
Organization Name:WOMEN'S DIAGNOSTIC CENTER OF BETHESDA INC
Other - Org Name:BETHESDA HEALTH COMPREHENSIVE IMAGING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-736-1200
Mailing Address - Street 1:2815 S SEACREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7969
Mailing Address - Country:US
Mailing Address - Phone:561-736-1200
Mailing Address - Fax:561-742-1919
Practice Address - Street 1:2623 S. SEACREST BLVD
Practice Address - Street 2:SUITE 50
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435
Practice Address - Country:US
Practice Address - Phone:561-736-1200
Practice Address - Fax:561-742-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty