Provider Demographics
NPI:1952404519
Name:PALM BEACH BROWARD MEDICAL IMAGING CENTER, INC.
Entity Type:Organization
Organization Name:PALM BEACH BROWARD MEDICAL IMAGING CENTER, INC.
Other - Org Name:RADIOLOGY EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-426-3006
Mailing Address - Street 1:1500 E HILLSBORO BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4356
Mailing Address - Country:US
Mailing Address - Phone:954-426-3006
Mailing Address - Fax:954-481-9318
Practice Address - Street 1:1500 E HILLSBORO BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4356
Practice Address - Country:US
Practice Address - Phone:954-426-3006
Practice Address - Fax:954-481-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3645261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05357A2OtherCAREPLUS
FL707585OtherWELLCARE STAYWELL
FLN1551OtherHEALTHEASE
FLSG017032OtherVISTA
FL065032300Medicaid
300022828OtherMEDICARE RAILROAD
FLAN30474120001OtherCIGNA
FLV2998OtherBLUE CROSS BLUE SHIELD
FL2240778OtherAETNA
NY0032120OtherGHI
FL003400OtherAVMED
FL3400023OtherUNITED HEALTHCARE
FL2240778OtherAETNA
FLSG017032OtherVISTA
FL=========COtherHUMANA
FL77906Medicare UPIN