MEDICARE: CONCEPT WEST EFL IMAGING CENTER LLC

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1740243260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCEPT WEST EFL IMAGING CENTER LLC

Provider Business Mailing Address
First Line	:	7639 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2534
Country	:	US
Telephone Number	:	561-966-6288
Fax Number	:	561-966-6765

Provider Business Practice Location Address
First Line	:	7639 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2534
Country	:	US
Telephone Number	:	561-966-6288
Fax Number	:	561-966-6765

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MIKE HOFFMAN
Credential	:
Telephone Number	:	561-838-3630

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	08/29/2007

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