Provider Demographics
NPI:1912505066
Name:UNIVERSIITY IMAGING CENTER LLC
Entity Type:Organization
Organization Name:UNIVERSIITY IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:H
Authorized Official - Last Name:RENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-713-0232
Mailing Address - Street 1:325 S DIXIE HWY STE 7
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-4423
Mailing Address - Country:US
Mailing Address - Phone:561-819-9106
Mailing Address - Fax:561-469-6719
Practice Address - Street 1:325 S DIXIE HWY STE 7
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-4423
Practice Address - Country:US
Practice Address - Phone:561-819-9106
Practice Address - Fax:561-469-6719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8551514324OtherAUTO
00000OtherAUTO