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General NPI Number Information
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NPI Number | 1831503804
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Entity Type | Organization
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Legal Business Name | PALM BEACH DIAGNOSTICS HOLDING, LLC
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 4215 BURNS RD SUITE 220
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4654
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Country | US
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Telephone | 813-238-3833
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Fax | 813-849-6349
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Provider Business Mailing Address
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Address Line | 607 W DR MARTIN LUTHER KING JR BLVD SUITE 103
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City | TAMPA
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State | FL
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Zip | 33603-3453
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Country | US
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Telephone | 813-238-3833
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MRS. TIFFANY KEMP
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Credential |
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Telephone | 813-325-1389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | FL
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