MEDICARE: PALM BEACH REGIONAL MRI INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40820	OTHER	FL	NEIGHBORHOOD HEALTH ID #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	72435	OTHER	FL	BCBS ID NUMBER

General Provider Information

NPI Number	:	1245236678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM BEACH REGIONAL MRI INC

Provider Business Mailing Address
First Line	:	173 MAIN ST
Second Line	:
City	:	THOMASTON
State	:	ME
Zip	:	04861-3807
Country	:	US
Telephone Number	:	561-882-0674
Fax Number	:	561-882-4141

Provider Business Practice Location Address
First Line	:	701 NORTHLAKE BLVD
Second Line	:	STE 106
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-5215
Country	:	US
Telephone Number	:	561-882-0674
Fax Number	:	561-882-4141

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. MARTIN J FARRELL
Credential	:
Telephone Number	:	207-706-6810

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	11/22/2018

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