Provider Demographics
NPI:1497820948
Name:IMED DIAGNOSTIC SERVICES OF SOUTHEAST FLORIDA LLC
Entity Type:Organization
Organization Name:IMED DIAGNOSTIC SERVICES OF SOUTHEAST FLORIDA LLC
Other - Org Name:INMED DIAGNOSTIC SERVICES OF SOUTHEAST FLORIDA LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STERNBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-218-9011
Mailing Address - Street 1:8903 GLADES RD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4074
Mailing Address - Country:US
Mailing Address - Phone:561-218-9011
Mailing Address - Fax:561-218-9012
Practice Address - Street 1:8903 GLADES RD
Practice Address - Street 2:SUITE B1
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4074
Practice Address - Country:US
Practice Address - Phone:561-218-9011
Practice Address - Fax:561-218-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7491261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2949OtherBLUECROSS BLUESHIELD
FLV2949OtherBLUECROSS BLUESHIELD