Provider Demographics
NPI:1376224956
Name:BROADER MRI OF PALM BEACH LLC
Entity Type:Organization
Organization Name:BROADER MRI OF PALM BEACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-766-0304
Mailing Address - Street 1:5405 OKEECHOBEE BLVD #100
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417
Mailing Address - Country:US
Mailing Address - Phone:561-766-0304
Mailing Address - Fax:305-768-9164
Practice Address - Street 1:5405 OKEECHOBEE BLVD #100
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417
Practice Address - Country:US
Practice Address - Phone:561-766-0304
Practice Address - Fax:305-768-9164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty