Provider Demographics
NPI:1013908912
Name:INDEPENDENT IMAGING, LLC
Entity Type:Organization
Organization Name:INDEPENDENT IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-766-1300
Mailing Address - Street 1:PO BOX 1313
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-1313
Mailing Address - Country:US
Mailing Address - Phone:561-766-1300
Mailing Address - Fax:561-318-7163
Practice Address - Street 1:3347 STATE ROAD 7
Practice Address - Street 2:SUITE 100
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8095
Practice Address - Country:US
Practice Address - Phone:561-795-5558
Practice Address - Fax:561-792-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8429261QR0200X
FLHCC1449261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV000BOtherBCBS
FL003527600Medicaid
FL003527600Medicaid