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General NPI Number Information
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NPI Number | 1114320272
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Entity Type | Organization
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Legal Business Name | ITR ANCILLIARY SERVICES LLC
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Dates
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Enumeration Date | 10/03/2014
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 3652 S SEACREST BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-8662
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Country | US
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Telephone | 561-894-8693
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Fax | 561-336-3238
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Provider Business Mailing Address
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Address Line | 3652 S SEACREST BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-8662
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Country | US
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Telephone | 561-894-8693
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Fax | 561-336-3238
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Authorized Official
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Title or Position | CEO
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Name | MR. HARVEY D BROWN
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Credential |
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Telephone | 561-894-8693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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