MEDICARE: IMAGING CENTER OF WEST PALM BEACH 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	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538152939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGING CENTER OF WEST PALM BEACH LLC

Provider Business Mailing Address
First Line	:	2450 METROCENTRE BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3105
Country	:	US
Telephone Number	:	561-684-9020
Fax Number	:	561-684-9060

Provider Business Practice Location Address
First Line	:	2450 METROCENTRE BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407
Country	:	US
Telephone Number	:	561-684-9020
Fax Number	:	561-684-9060

Authorized Official
Title or Position	:	MD
Name	:	DR. RICHARD SARNER
Credential	:	MD
Telephone Number	:	561-766-1301

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	05/16/2018

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