Provider Demographics
NPI:1639507585
Name:BEACHES MRI OF PSL, LLC
Entity Type:Organization
Organization Name:BEACHES MRI OF PSL, LLC
Other - Org Name:BEACHES MRI OF PSL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-323-7321
Mailing Address - Street 1:1615 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9629
Mailing Address - Country:US
Mailing Address - Phone:772-337-9191
Mailing Address - Fax:772-337-7772
Practice Address - Street 1:10377 S US HIGHWAY 1
Practice Address - Street 2:STE 100
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5630
Practice Address - Country:US
Practice Address - Phone:772-337-9191
Practice Address - Fax:772-337-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEXEMPT2085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty