Basic Information
| Provider Information | |||||||||
| NPI: | 1053559930 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | A1 IMAGING OFBOYNTON BEACH LLC | ||||||||
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| OtherOrganizationName: | A1 IMAGING OF BOYNTON BEACH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 2ND ST | ||||||||
| Address2: | SUITE 915 | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342365946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413159876 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3795 W BOYNTON BEACH BLVD | ||||||||
| Address2: | STE C | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334364502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617400221 | ||||||||
| FaxNumber: | 5617409305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2009 | ||||||||
| LastUpdateDate: | 12/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | RADAKOVIC | ||||||||
| AuthorizedOfficialFirstName: | MARILYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 9513156661 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | A1 IMAGING CENTER LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | HCC5193 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
No ID Information.