Healthcare Provider Details

I. General information

NPI: 1932431913
Provider Name (Legal Business Name): RADIOLOGY MANAGEMENT GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 S CROWN WAY SUITE 1
WELLINGTON FL
33414-8792
US

IV. Provider business mailing address

11101 S CROWN WAY SUITE 1
WELLINGTON FL
33414-8792
US

V. Phone/Fax

Practice location:
  • Phone: 561-795-9150
  • Fax: 561-798-7700
Mailing address:
  • Phone: 561-795-9150
  • Fax: 561-798-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE MOORE
Title or Position: MANAGED CARE SPECIALIST
Credential:
Phone: 561-795-9150