Provider Demographics
NPI:1508233487
Name:INDEPENDENT IMAGING, LLC
Entity Type:Organization
Organization Name:INDEPENDENT IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:GHIRAGOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-766-1300
Mailing Address - Street 1:PO BOX 1313
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-1313
Mailing Address - Country:US
Mailing Address - Phone:561-795-5558
Mailing Address - Fax:561-792-7300
Practice Address - Street 1:701 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-4201
Practice Address - Country:US
Practice Address - Phone:561-795-5558
Practice Address - Fax:561-792-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty