Provider Demographics
NPI:1194887539
Name:PALM BEACH RADIOLOGY AND IMAGING ASSOCIATES
Entity type:Organization
Organization Name:PALM BEACH RADIOLOGY AND IMAGING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE DEPARTMENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-841-8588
Mailing Address - Street 1:733 US HIGHWAY 1 BLDG 2B
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4513
Mailing Address - Country:US
Mailing Address - Phone:561-841-8588
Mailing Address - Fax:561-841-8533
Practice Address - Street 1:733 US HIGHWAY 1 BLDG 2B
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4513
Practice Address - Country:US
Practice Address - Phone:561-841-8588
Practice Address - Fax:561-841-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL200720481261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN272625OtherHEALTHEASE HEALTHPLAN
FLN272625OtherSOUTH FLORIDA REGION HEAL
FL377844400Medicaid
FL33933OtherBCBS
FLN272625OtherWELLCARE
FLN272625OtherSTAYWELL
FLN272625OtherWELLCARE