=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043666415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHPOINT DIAGNOSTIC GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2016
-----------------------------------------------------
Last Update Date | 05/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 NORTHPOINT PKWY SUITE P4
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33407-1973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-807-8552
-----------------------------------------------------
Fax | 561-807-8553
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 NORTHPOINT PKWY SUITE P4
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33407-1973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-807-8552
-----------------------------------------------------
Fax | 561-807-8553
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | TAMMY CARPENTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-807-8552
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | ME31479
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | ME116999
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------