Provider Demographics
NPI:1114989217
Name:OMI OF BOYNTON BEACH INC
Entity Type:Organization
Organization Name:OMI OF BOYNTON BEACH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BABITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-888-6411
Mailing Address - Street 1:2200 N COMMERCE PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326
Mailing Address - Country:US
Mailing Address - Phone:954-888-6411
Mailing Address - Fax:954-888-6414
Practice Address - Street 1:901 N CONGRESS AVENUE
Practice Address - Street 2:SUITE D107
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426
Practice Address - Country:US
Practice Address - Phone:561-731-0177
Practice Address - Fax:561-731-5816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E1786AMedicare ID - Type Unspecified