Provider Demographics
NPI:1245236678
Name:PALM BEACH REGIONAL MRI INC
Entity Type:Organization
Organization Name:PALM BEACH REGIONAL MRI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-706-6810
Mailing Address - Street 1:173 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:ME
Mailing Address - Zip Code:04861-3807
Mailing Address - Country:US
Mailing Address - Phone:561-882-0674
Mailing Address - Fax:561-882-4141
Practice Address - Street 1:701 NORTHLAKE BLVD
Practice Address - Street 2:STE 106
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5215
Practice Address - Country:US
Practice Address - Phone:561-882-0674
Practice Address - Fax:561-882-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2018-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40820OtherNEIGHBORHOOD HEALTH ID #
FL510017800Medicaid
FL72435OtherBCBS ID NUMBER
FL40820OtherNEIGHBORHOOD HEALTH ID #