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General NPI Number Information
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NPI Number | 1881783553
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Entity Type | Organization
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Legal Business Name | BEACHES OPEN MRI OF PBG LLC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2701 PGA BLVD SUITE A
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410
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Country | US
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Telephone | 561-627-1111
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Fax | 561-627-6677
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Provider Business Mailing Address
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Address Line | 2701 PGA BLVD SUITE A
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410
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Country | US
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Telephone | 561-627-1111
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Fax | 561-627-6677
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Authorized Official
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Title or Position | OFFICER
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Name | ANDREW T WALKER
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Credential | MD
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Telephone | 772-878-5858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME0058016
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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 | ME0061896
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME0070441
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License Number State | FL
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