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General NPI Number Information
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NPI Number | 1639507585
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Entity Type | Organization
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Legal Business Name | BEACHES MRI OF PSL, LLC
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Dates
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Enumeration Date | 10/30/2013
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 10377 S US HIGHWAY 1 STE 100
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5630
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Country | US
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Telephone | 772-337-9191
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Fax | 772-337-7772
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Provider Business Mailing Address
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Address Line | 1615 NW FEDERAL HWY
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City | STUART
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State | FL
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Zip | 34994-9629
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Country | US
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Telephone | 772-337-9191
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Fax | 772-337-7772
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Authorized Official
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Title or Position | OFFICER
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Name | DR. ANDREW T WALKER
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Credential | M.D.
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Telephone | 772-323-7321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | EXEMPT
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | EXEMPT
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License Number State | FL
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