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General NPI Number Information
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NPI Number | 1568693844
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Entity Type | Organization
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Legal Business Name | NOMADIC IMAGING, INC
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 603 LAKE AVE
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City | LAKE WORTH
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State | FL
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Zip | 33460-3810
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Country | US
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Telephone | 561-602-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 603 LAKE AVE
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City | LAKE WORTH
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State | FL
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Zip | 33460-3810
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Country | US
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Telephone | 561-602-4300
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | DEREK LUCCHESI
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Credential |
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Telephone | 561-602-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | CRT70888
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License Number State | FL
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