Healthcare Provider Details

I. General information

NPI: 1285833012
Provider Name (Legal Business Name): FGMX IMAGING SERVICES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 S LINCOLN ST
KNOXVILLE IA
50138-3121
US

IV. Provider business mailing address

PO BOX 2400
WATERLOO IA
50704-2400
US

V. Phone/Fax

Practice location:
  • Phone: 641-842-2151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: FRED MARGOLIN
Title or Position: DO
Credential:
Phone: 319-233-3044