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General NPI Number Information
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NPI Number | 1588988356
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Entity Type | Organization
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Legal Business Name | CONTERMPORARY IMAGING LLC
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 1135 RIALTO DR
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-7196
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Country | US
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Telephone | 561-901-5242
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Fax |
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Provider Business Mailing Address
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Address Line | 1135 RIALTO DR
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-7196
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Country | US
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Telephone | 561-901-5242
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MRS. KRISTI LYNN ENNIS
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Credential | RDMS R.T. (VS)
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Telephone | 561-901-5242
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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 | L10000023489
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License Number State | FL
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