Basic Information
| Provider Information | |||||||||
| NPI: | 1023555794 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WOMEN'S DIAGNOSTIC CENTER OF BETHESDA INC | ||||||||
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| OtherOrganizationName: | BETHESDA HEALTH COMPREHENSIVE IMAGING SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2815 S SEACREST BLVD | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334357969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617361200 | ||||||||
| FaxNumber: | 5617421919 | ||||||||
| Practice Location | |||||||||
| Address1: | 2623 S. SEACREST BLVD | ||||||||
| Address2: | SUITE 50 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617361200 | ||||||||
| FaxNumber: | 5617421919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2017 | ||||||||
| LastUpdateDate: | 01/19/2017 | ||||||||
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| AuthorizedOfficialLastName: | KIRK | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5617361200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.