MEDICARE: WELLINGTON REGIONAL DIAGNOSTIC CENTER,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0206X	Mammography Clinic/Center

General Provider Information

NPI Number	:	1275566838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLINGTON REGIONAL DIAGNOSTIC CENTER,LLC

Provider Business Mailing Address
First Line	:	3537 FOREST HILL BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5867
Country	:	US
Telephone Number	:	727-585-7020
Fax Number	:	727-450-1144

Provider Business Practice Location Address
First Line	:	3537 FOREST HILL BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5867
Country	:	US
Telephone Number	:	727-585-7020
Fax Number	:	727-450-1144

Authorized Official
Title or Position	:	CEO
Name	:	MR. KEVIN DILALLO
Credential	:
Telephone Number	:	727-585-7020

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/22/2020

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