Provider Demographics
NPI:1477607117
Name:WOMENS DIAGNOSTIC CENTER, INC
Entity Type:Organization
Organization Name:WOMENS DIAGNOSTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-684-5144
Mailing Address - Street 1:1357 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4841
Mailing Address - Country:US
Mailing Address - Phone:813-684-5144
Mailing Address - Fax:813-684-5084
Practice Address - Street 1:1357 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4841
Practice Address - Country:US
Practice Address - Phone:813-684-5144
Practice Address - Fax:813-684-5084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0200X
FL161638261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0427Medicare ID - Type Unspecified