=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225402464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IMAGING CENTER OF WEST PALM BEACH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2015
-----------------------------------------------------
Last Update Date | 05/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4800 LINTON BLVD SUITE A-203
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33445-6584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-684-9020
-----------------------------------------------------
Fax | 561-684-9060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 737475
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75373-7475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-624-9020
-----------------------------------------------------
Fax | 561-684-9060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | GREG GAMBILL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-414-2037
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------