Provider Demographics
NPI:1225402464
Name:IMAGING CENTER OF WEST PALM BEACH,LLC
Entity Type:Organization
Organization Name:IMAGING CENTER OF WEST PALM BEACH,LLC
Other - Org Name:IMAGING CENTER OF DELRAY BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-300-2777
Mailing Address - Street 1:2450 METROCENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3105
Mailing Address - Country:US
Mailing Address - Phone:561-624-9020
Mailing Address - Fax:561-684-9060
Practice Address - Street 1:4800 LINTON BLVD
Practice Address - Street 2:SUITE A-203
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6584
Practice Address - Country:US
Practice Address - Phone:561-684-9020
Practice Address - Fax:561-684-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-28
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)