Provider Demographics
NPI:1578526414
Name:PALM BEACH EFL IMAGING CENTER LLC
Entity Type:Organization
Organization Name:PALM BEACH EFL IMAGING CENTER LLC
Other - Org Name:PALM BEACH OPEN IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-838-3630
Mailing Address - Street 1:1515 N FLAGLER DR
Mailing Address - Street 2:SUITE 720
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3428
Mailing Address - Country:US
Mailing Address - Phone:561-838-3600
Mailing Address - Fax:561-804-9949
Practice Address - Street 1:1515 N FLAGLER DR
Practice Address - Street 2:SUITE 720
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3428
Practice Address - Country:US
Practice Address - Phone:561-838-3618
Practice Address - Fax:561-804-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272379400Medicaid
FL272379400Medicaid