Provider Demographics
NPI:1619198819
Name:MID-TOWN SPORTS IMAGING LLC
Entity Type:Organization
Organization Name:MID-TOWN SPORTS IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:EASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-747-4410
Mailing Address - Street 1:10274 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3940
Mailing Address - Country:US
Mailing Address - Phone:954-747-4410
Mailing Address - Fax:954-747-4424
Practice Address - Street 1:10274 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3940
Practice Address - Country:US
Practice Address - Phone:954-747-4410
Practice Address - Fax:954-747-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035538261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology