Healthcare Provider Details

I. General information

NPI: 1285773176
Provider Name (Legal Business Name): PHYSICIANS IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SE MONTEREY ROAD SUITE #102
STUART FL
34994
US

IV. Provider business mailing address

1050 SE MONTEREY ROAD SUITE #102
STUART FL
34994
US

V. Phone/Fax

Practice location:
  • Phone: 772-220-9700
  • Fax: 772-463-4034
Mailing address:
  • Phone: 772-220-9700
  • Fax: 772-463-4034

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: DR. YONAS ZEGEYE
Title or Position: OWNER
Credential: MD
Phone: 772-463-4033