Provider Demographics
NPI:1205840071
Name:BETHESDA HEALTH COMPREHENSIVE IMAGING SERVICES, INC.
Entity Type:Organization
Organization Name:BETHESDA HEALTH COMPREHENSIVE IMAGING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:AQUILINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-736-1200
Mailing Address - Street 1:2815 S SEACREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7934
Mailing Address - Country:US
Mailing Address - Phone:561-737-7733
Mailing Address - Fax:561-737-4534
Practice Address - Street 1:10301 HAGEN RANCH RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3724
Practice Address - Country:US
Practice Address - Phone:561-374-5300
Practice Address - Fax:561-374-5310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
97636Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER