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General NPI Number Information
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NPI Number | 1477721405
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Entity Type | Organization
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Legal Business Name | WEST BOYNTON BEACH OPEN IMAGING CENTER LLC
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 02/20/2010
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Provider Practice Location Address
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Address Line | 10151 ENTERPRISE CENTER BLVD SUITE 109
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3759
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Country | US
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Telephone | 561-752-5050
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Fax | 561-364-5606
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Provider Business Mailing Address
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Address Line | 10151 ENTERPRISE CENTER BLVD SUITE 109
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3759
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Country | US
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Telephone | 561-752-5050
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Fax | 561-346-5606
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Authorized Official
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Title or Position | COORDINATOR
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Name | LAVELLE R HARDIN
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Credential |
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Telephone | 615-344-8203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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