Provider Demographics
NPI:1033299516
Name:NEW LIFE IMAGING INC
Entity Type:Organization
Organization Name:NEW LIFE IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:772-785-8000
Mailing Address - Street 1:501 NW LAKE WHITNEY PLACE
Mailing Address - Street 2:SUITE #106
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3443
Mailing Address - Country:US
Mailing Address - Phone:772-785-8000
Mailing Address - Fax:772-785-8150
Practice Address - Street 1:501 NW LAKE WHITNEY PLACE
Practice Address - Street 2:SUITE #106
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3443
Practice Address - Country:US
Practice Address - Phone:772-785-8000
Practice Address - Fax:772-785-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL510001100Medicaid
FLV2026OtherBLUE SHIELD
FLE3076Medicare PIN