Provider Demographics
NPI:1275566838
Name:WELLINGTON REGIONAL DIAGNOSTIC CENTER,LLC
Entity Type:Organization
Organization Name:WELLINGTON REGIONAL DIAGNOSTIC CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DILALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-585-7020
Mailing Address - Street 1:3537 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5867
Mailing Address - Country:US
Mailing Address - Phone:727-585-7020
Mailing Address - Fax:727-450-1144
Practice Address - Street 1:3537 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5867
Practice Address - Country:US
Practice Address - Phone:727-585-7020
Practice Address - Fax:727-450-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5817Medicare ID - Type Unspecified