MEDICARE: INDEPENDENT IMAGING, 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	HCC9378	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V007N	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629406293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT IMAGING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1313
Second Line	:
City	:	LOXAHATCHEE
State	:	FL
Zip	:	33470-1313
Country	:	US
Telephone Number	:	561-766-1301
Fax Number	:	561-318-7163

Provider Business Practice Location Address
First Line	:	5051 S CONGRESS AVE
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4704
Country	:	US
Telephone Number	:	561-795-5558
Fax Number	:	561-792-7300

Authorized Official
Title or Position	:	OWNER
Name	:	ARTHUR HANSEN
Credential	:
Telephone Number	:	561-204-4800

Provider Enumeration Date	:	10/17/2013
Last Update Date	:	10/17/2013

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Directions to “INDEPENDENT IMAGING, LLC ” Practice Location

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