Provider Demographics
NPI:1457478000
Name:INMED DIAGNOSTIC SERVICES OF MASSACHUSETTS LLC
Entity Type:Organization
Organization Name:INMED DIAGNOSTIC SERVICES OF MASSACHUSETTS LLC
Other - Org Name:INMED DIAGNOSTIC WOMEN'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AM
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-206-6198
Mailing Address - Street 1:2400 E COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 826
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4054
Mailing Address - Country:US
Mailing Address - Phone:954-510-3700
Mailing Address - Fax:954-510-2649
Practice Address - Street 1:600 LONGWATER DR STE 105
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1639
Practice Address - Country:US
Practice Address - Phone:781-878-4004
Practice Address - Fax:781-878-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232640261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1529510Medicaid
MA1529510Medicaid