Provider Demographics
NPI:1639266224
Name:BEACH MEDICAL IMAGING, PA
Entity Type:Organization
Organization Name:BEACH MEDICAL IMAGING, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEURO/NEUROINTERVENTIONAL RADIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:BEIRNE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:321-773-9898
Mailing Address - Street 1:2033 S PATRICK DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4418
Mailing Address - Country:US
Mailing Address - Phone:321-773-9898
Mailing Address - Fax:321-773-3354
Practice Address - Street 1:2033 S PATRICK DR
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4418
Practice Address - Country:US
Practice Address - Phone:321-773-9898
Practice Address - Fax:321-773-3326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65710261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology