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General NPI Number Information
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NPI Number | 1912505066
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Entity Type | Organization
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Legal Business Name | UNIVERSIITY IMAGING CENTER LLC
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 325 S DIXIE HWY STE 7
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City | LAKE WORTH
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State | FL
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Zip | 33460-4423
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Country | US
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Telephone | 561-819-9106
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Fax | 561-469-6719
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Provider Business Mailing Address
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Address Line | 325 S DIXIE HWY STE 7
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City | LAKE WORTH
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State | FL
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Zip | 33460-4423
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Country | US
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Telephone | 561-819-9106
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Fax | 561-469-6719
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Authorized Official
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Title or Position | SENIOR MEMBER
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Name | MR. CARL H RENE
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Credential |
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Telephone | 561-713-0232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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