Provider Demographics
NPI:1952353856
Name:WESTERN IMAGING INC
Entity type:Organization
Organization Name:WESTERN IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:
Authorized Official - Phone:561-795-9150
Mailing Address - Street 1:11101 S CROWN WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8792
Mailing Address - Country:US
Mailing Address - Phone:561-795-9150
Mailing Address - Fax:561-798-7700
Practice Address - Street 1:11101 S CROWN WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8792
Practice Address - Country:US
Practice Address - Phone:561-795-9150
Practice Address - Fax:561-798-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2647745-00Medicaid
34294Medicare ID - Type Unspecified
FL34294Medicare PIN