Provider Demographics
NPI:1740243260
Name:CONCEPT WEST EFL IMAGING CENTER LLC
Entity Type:Organization
Organization Name:CONCEPT WEST EFL IMAGING CENTER LLC
Other - Org Name:CONCEPT WEST OPEN IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-838-3630
Mailing Address - Street 1:7639 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2534
Mailing Address - Country:US
Mailing Address - Phone:561-966-6288
Mailing Address - Fax:561-966-6765
Practice Address - Street 1:7639 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2534
Practice Address - Country:US
Practice Address - Phone:561-966-6288
Practice Address - Fax:561-966-6765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4901Medicare UPIN