Healthcare Provider Details

I. General information

NPI: 1669878526
Provider Name (Legal Business Name): MEDICAL CENTER IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W CYPRESS CREEK RD SUITE C11
FT LAUDERDALE FL
33309-1744
US

IV. Provider business mailing address

4623 FOREST HILL BLVD SUITE 101
WEST PALM BEACH FL
33415-7469
US

V. Phone/Fax

Practice location:
  • Phone: 954-974-6191
  • Fax:
Mailing address:
  • Phone: 561-967-8888
  • Fax: 561-641-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateFL

VIII. Authorized Official

Name: RUSS SEGER
Title or Position: PRESIDENT OWNER
Credential: D C
Phone: 561-967-8888