Provider Demographics
NPI:1124010855
Name:SOUTHEAST MEDICAL IMAGING SERVICES INC
Entity Type:Organization
Organization Name:SOUTHEAST MEDICAL IMAGING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:561-865-3660
Mailing Address - Street 1:4800 LINTON BLVD
Mailing Address - Street 2:SUITE D-503
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6584
Mailing Address - Country:US
Mailing Address - Phone:561-865-3660
Mailing Address - Fax:561-865-3661
Practice Address - Street 1:4800 LINTON BLVD
Practice Address - Street 2:SUITE D-503
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6584
Practice Address - Country:US
Practice Address - Phone:561-865-3660
Practice Address - Fax:561-865-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4109Medicare ID - Type Unspecified