Provider Demographics
NPI:1033357926
Name:A1 IMAGING OF WEST PALM BEACH LLC
Entity Type:Organization
Organization Name:A1 IMAGING OF WEST PALM BEACH LLC
Other - Org Name:A1 IMAGING OF WEST PALM BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RADAKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-285-6661
Mailing Address - Street 1:1800 2ND ST
Mailing Address - Street 2:STE 915
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5946
Mailing Address - Country:US
Mailing Address - Phone:941-315-9876
Mailing Address - Fax:
Practice Address - Street 1:1117 N OLIVE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3520
Practice Address - Country:US
Practice Address - Phone:561-651-7410
Practice Address - Fax:561-651-7417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A1 IMAGING CENTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-30
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7846261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBB331Medicare PIN