Provider Demographics
NPI:1073637526
Name:SIGNET DIAGNOSTIC IMAGING SERVICES LLC
Entity Type:Organization
Organization Name:SIGNET DIAGNOSTIC IMAGING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-577-5836
Mailing Address - Street 1:560 SOUTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5027
Mailing Address - Country:US
Mailing Address - Phone:516-933-2800
Mailing Address - Fax:516-822-4348
Practice Address - Street 1:8300 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5406
Practice Address - Country:US
Practice Address - Phone:954-577-6000
Practice Address - Fax:954-577-5816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8667GMedicare PIN
FLE8667EMedicare PIN
FLE8667Medicare PIN
FLE8667CMedicare PIN
FLE8667DMedicare PIN
FLE8667IMedicare PIN
FLE8667AMedicare PIN
FLE8667HMedicare PIN
FLE8667FMedicare PIN
FLE8667BMedicare PIN
FLE8667JMedicare PIN