Healthcare Provider Details

I. General information

NPI: 1851694418
Provider Name (Legal Business Name): CROSS COUNTRY DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N MILITARY TRL STE 420
BOCA RATON FL
33431-6315
US

IV. Provider business mailing address

2600 N MILITARY TRL STE 420
BOCA RATON FL
33431-6315
US

V. Phone/Fax

Practice location:
  • Phone: 888-395-4007
  • Fax:
Mailing address:
  • Phone: 888-395-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberME94215
License Number StateFL

VIII. Authorized Official

Name: VIVEK GUPTA
Title or Position: MD
Credential: MD
Phone: 888-395-4007