Provider Demographics
NPI:1770652984
Name:MIDTOWN IMAGING LLC
Entity Type:Organization
Organization Name:MIDTOWN IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-697-3001
Mailing Address - Street 1:PO BOX 850001
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0364
Mailing Address - Country:US
Mailing Address - Phone:561-697-3001
Mailing Address - Fax:561-209-6377
Practice Address - Street 1:2529 BURNS RD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-5204
Practice Address - Country:US
Practice Address - Phone:561-625-4441
Practice Address - Fax:561-209-6377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE9133AMedicare PIN