Provider Demographics
NPI:1831503804
Name:PALM BEACH DIAGNOSTICS HOLDING, LLC
Entity type:Organization
Organization Name:PALM BEACH DIAGNOSTICS HOLDING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-325-1389
Mailing Address - Street 1:607 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3453
Mailing Address - Country:US
Mailing Address - Phone:813-238-3833
Mailing Address - Fax:
Practice Address - Street 1:4215 BURNS RD
Practice Address - Street 2:SUITE 220
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4654
Practice Address - Country:US
Practice Address - Phone:813-238-3833
Practice Address - Fax:813-849-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology