=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033299516
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW LIFE IMAGING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2006
-----------------------------------------------------
Last Update Date | 07/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 NW LAKE WHITNEY PLACE SUITE #106
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34986-3443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-785-8000
-----------------------------------------------------
Fax | 772-785-8150
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 NW LAKE WHITNEY PLACE SUITE #106
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34986-3443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-785-8000
-----------------------------------------------------
Fax | 772-785-8150
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | MRS. SUSAN A BROWN
-----------------------------------------------------
Credential | RDMS
-----------------------------------------------------
Telephone | 772-785-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------