Healthcare Provider Details

I. General information

NPI: 1669651469
Provider Name (Legal Business Name): BOCA RATON OPEN IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CLINT MOORE RD SUITE 140
BOCA RATON FL
33487-2768
US

IV. Provider business mailing address

401 MAPLEWOOD DR SUITE 10
JUPITER FL
33458-5849
US

V. Phone/Fax

Practice location:
  • Phone: 561-939-0850
  • Fax: 561-939-0899
Mailing address:
  • Phone: 561-741-4330
  • Fax: 561-741-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. GARTH LAWSON
Title or Position: COO
Credential:
Phone: 561-838-3630