Healthcare Provider Details

I. General information

NPI: 1497820948
Provider Name (Legal Business Name): IMED DIAGNOSTIC SERVICES OF SOUTHEAST FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8903 GLADES RD SUITE B1
BOCA RATON FL
33434-4074
US

IV. Provider business mailing address

8903 GLADES RD SUITE B1
BOCA RATON FL
33434-4074
US

V. Phone/Fax

Practice location:
  • Phone: 561-218-9011
  • Fax: 561-218-9012
Mailing address:
  • Phone: 561-218-9011
  • Fax: 561-218-9012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberHCC7491
License Number StateFL

VIII. Authorized Official

Name: MR. ALAN STERNBERG
Title or Position: MANAGING PARTNER
Credential:
Phone: 561-218-9011