MEDICARE: GLADES IMAGING 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1346349719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLADES IMAGING CENTER LLC

Provider Business Mailing Address
First Line	:	1157 S STATE ROAD 7
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6101
Country	:	US
Telephone Number	:	561-762-7170
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 S MAIN ST
Second Line	:	SUITE 103
City	:	BELLE GLADE
State	:	FL
Zip	:	33430-7808
Country	:	US
Telephone Number	:	561-762-7170
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JORGE DANIEL GHIRAGOSSIAN
Credential	:	M.D.
Telephone Number	:	561-762-7170

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/22/2020

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