Provider Demographics
NPI:1114250453
Name:FLORIDA RADIOLOGY SPECIALISTS, P.L.
Entity Type:Organization
Organization Name:FLORIDA RADIOLOGY SPECIALISTS, P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-736-1200
Mailing Address - Street 1:200 KNUTH RD
Mailing Address - Street 2:STE 200
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4693
Mailing Address - Country:US
Mailing Address - Phone:561-736-1200
Mailing Address - Fax:561-742-1919
Practice Address - Street 1:3301 EVENTIDE PL
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9143
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:2009-09-17
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0026694-00Medicaid
FLDQ7718OtherRAILROAD MEDICARE
FL001LKOtherBCBS OF FLORIDA
FL0026694-00Medicaid