SPECIALISTS IN DIAGNOSTIC IMAGING PA

Provider Demographics

• NPI: 1558347724
• Name: SPECIALISTS IN DIAGNOSTIC IMAGING PA
• Entity Type: Organization
• Organization Name: SPECIALISTS IN DIAGNOSTIC IMAGING PA
• Authorized Official - Title/Position: DIRECTOR OF OPERATIONS
• Authorized Official - Prefix: MRS
• Authorized Official - First Name: KAREN
• Authorized Official - Last Name: JODAT
• Authorized Official - Phone: 954-698-9399
• Mailing Address - Street 1: 629A E HILLSBORO BLVD
• Mailing Address - Street 2: SUITE A
• Mailing Address - City: DEERFIELD BEACH
• Mailing Address - State: FL
• Mailing Address - Zip Code: 33441-3517
• Mailing Address - Country: US
• Mailing Address - Phone: 954-698-9399
• Mailing Address - Fax: 954-698-6963
• Practice Address - Street 1: 629A E HILLSBORO BLVD
• Practice Address - City: DEERFIELD BEACH
• Practice Address - State: FL
• Practice Address - Zip Code: 33441-3517
• Practice Address - Country: US
• Practice Address - Phone: 954-698-9399
• Practice Address - Fax: 954-698-6963
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-12-20
• Last Update Date: 2018-02-19

Provider Licenses

State	License ID	Taxonomies
FL	ME65690	2085R0202X
FL	ME55202	2085R0202X
FL	ME89839	2085R0202X
FL	ME91665	2085R0202X
FL	103039	2085R0202X
FL	102211	2085R0202X
FL	91257	2085R0202X
FL	60421	2085R0202X
FL	98042	2085R0202X
FL	86013	2085R0202X
FL	98490	2085R0202X
FL	65003	2085R0202X
VA	ME60421	2085R0202X
NC	ME89839	2085R0202X
FL	ME 94156	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
FL	DA7190	Medicare PIN
VA	0101051960	Medicare PIN
FL	K4017	Medicare PIN
NC	2335909	Medicare PIN
NJ	236891	Medicare PIN
FL	ME 88252	Medicare PIN
CO	COA106191	Medicare PIN
FL	U1264I	Medicare PIN
MA	0026326	Medicare PIN
WA	G8910372	Medicare PIN
FL	U1264J	Medicare PIN
MA	002633001	Medicare PIN
PA	142398	Medicare PIN
NY	A100070752	Medicare PIN
CA	CE032A	Medicare PIN
FL	U1264Z	Medicare PIN
CA	CE032B	Medicare PIN
FL	ME 80341	Medicare PIN
TX	0A3106	Medicare PIN
WA	G8910405	Medicare PIN
VA	GC1160	Medicare PIN
FL	K4017A	Medicare PIN
IN	M100070697	Medicare PIN