Healthcare Provider Details

I. General information

NPI: 1124010855
Provider Name (Legal Business Name): SOUTHEAST MEDICAL IMAGING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 LINTON BLVD STE D503
DELRAY BEACH FL
33445-6593
US

IV. Provider business mailing address

4800 LINTON BLVD SUITE D-503
DELRAY BEACH FL
33445-6584
US

V. Phone/Fax

Practice location:
  • Phone: 561-865-3660
  • Fax: 561-865-3661
Mailing address:
  • Phone: 561-865-3660
  • Fax: 561-865-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEXIS F CRUZ
Title or Position: PRESIDENT
Credential: RDMS
Phone: 561-865-3660