MEDICARE: GARDENS EFL 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

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	:	1639129349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDENS EFL IMAGING CENTER LLC

Provider Business Mailing Address
First Line	:	3335 BURNS RD
Second Line	:	SUITE 101
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4322
Country	:	US
Telephone Number	:	561-627-6227
Fax Number	:

Provider Business Practice Location Address
First Line	:	3335 BURNS RD
Second Line	:	SUITE 101
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4322
Country	:	US
Telephone Number	:	561-627-6227
Fax Number	:

Authorized Official
Title or Position	:	VP IMAGING SERVICES
Name	:	WANDA FOGARTY
Credential	:
Telephone Number	:	561-838-3630

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	05/18/2010

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