MEDICARE: STAND-UP MRI OF BOCA RATON, PA

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	2085R0202X	Diagnostic Radiology Physician		FL

General Provider Information

NPI Number	:	1306811104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAND-UP MRI OF BOCA RATON, PA

Provider Business Mailing Address
First Line	:	9080 KIMBERLY BLVD
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33434-2862
Country	:	US
Telephone Number	:	561-470-1890
Fax Number	:	561-470-1891

Provider Business Practice Location Address
First Line	:	9080 KIMBERLY BLVD
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33434-2862
Country	:	US
Telephone Number	:	561-470-1890
Fax Number	:	561-470-1891

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	LLOYD WAXMAN
Credential	:
Telephone Number	:	631-694-2816

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	02/20/2008

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