Provider Demographics
NPI:1720315294
Name:ELITE HEALTH DIAGNOSTIC CENTER PA
Entity Type:Organization
Organization Name:ELITE HEALTH DIAGNOSTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WELBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-957-8818
Mailing Address - Street 1:1601 N PALM AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3200
Mailing Address - Country:US
Mailing Address - Phone:305-957-8818
Mailing Address - Fax:305-957-7234
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-672-9989
Practice Address - Fax:305-672-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty