Provider Demographics
NPI:1669819793
Name:IMAGING TEKNIX, LLC
Entity Type:Organization
Organization Name:IMAGING TEKNIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-494-3032
Mailing Address - Street 1:4251 MANGRUM CT
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2419
Mailing Address - Country:US
Mailing Address - Phone:954-494-3032
Mailing Address - Fax:954-962-4717
Practice Address - Street 1:3800 JOHNSON STREET
Practice Address - Street 2:SUITE C
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-962-4700
Practice Address - Fax:954-962-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEXEMPT261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology