Provider Demographics
NPI:1346349719
Name:GLADES IMAGING CENTER LLC
Entity Type:Organization
Organization Name:GLADES IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:GHIRAGOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-762-7170
Mailing Address - Street 1:1157 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6101
Mailing Address - Country:US
Mailing Address - Phone:561-762-7170
Mailing Address - Fax:
Practice Address - Street 1:1200 S MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-7808
Practice Address - Country:US
Practice Address - Phone:561-762-7170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty