Provider Demographics
NPI:1700877602
Name:PALMS WEST IMAGING INC
Entity Type:Organization
Organization Name:PALMS WEST IMAGING INC
Other - Org Name:PALMS WEST OPEN MRI - RPB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-795-9150
Mailing Address - Street 1:11337 OKEECHOBEE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8732
Mailing Address - Country:US
Mailing Address - Phone:561-795-5558
Mailing Address - Fax:561-792-7300
Practice Address - Street 1:11337 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8732
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:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC1448261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2350OtherBCBS IDTF
FL33783Medicare ID - Type Unspecified