Provider Demographics
NPI:1962749952
Name:ADVANCED MEDICAL IMAGING AND TELERADIOLOGY LLC
Entity type:Organization
Organization Name:ADVANCED MEDICAL IMAGING AND TELERADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-264-3344
Mailing Address - Street 1:1489 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 357
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3325
Mailing Address - Country:US
Mailing Address - Phone:888-264-3344
Mailing Address - Fax:
Practice Address - Street 1:1489 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 357
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3325
Practice Address - Country:US
Practice Address - Phone:888-264-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty