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General NPI Number Information
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NPI Number | 1134116726
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Entity Type | Organization
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Legal Business Name | DESTIN REGIONAL IMAGING CENTER LLC
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 7800 US HIGHWAY 98 W
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-7228
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Country | US
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Telephone | 850-278-3555
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Fax | 850-278-3562
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Provider Business Mailing Address
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Address Line | PO BOX 1977
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-1977
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Country | US
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Telephone | 855-410-3201
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Fax | 855-853-5098
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. CHUN W CHEN
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Credential | MD
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Telephone | 850-278-3555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME89464
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | ME74820
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME86615
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License Number State | FL
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