Provider Demographics
NPI:1700849221
Name:BOYNTON BEACH EFL IMAGING CENTER LLC
Entity Type:Organization
Organization Name:BOYNTON BEACH EFL IMAGING CENTER LLC
Other - Org Name:BOYNTON BEACH OPEN IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP IMAGING SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-838-3630
Mailing Address - Street 1:2300 S CONGRESS AVE
Mailing Address - Street 2:SUITE105
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-7400
Mailing Address - Country:US
Mailing Address - Phone:561-733-5001
Mailing Address - Fax:561-733-0208
Practice Address - Street 1:2300 S CONGRESS AVE
Practice Address - Street 2:SUITE105
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7400
Practice Address - Country:US
Practice Address - Phone:561-733-5001
Practice Address - Fax:561-733-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272376000Medicaid
FL272376000Medicaid