Basic Information
| Provider Information | |||||||||
| NPI: | 1831117738 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMPERIAL POINT EKG READERS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 198474 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 303848474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547261808 | ||||||||
| FaxNumber: | 9547261820 | ||||||||
| Practice Location | |||||||||
| Address1: | 6401 N FEDERAL HWY | ||||||||
| Address2: | EKG READERS PANEL | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333081427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547768500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 07/01/2014 | ||||||||
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| AuthorizedOfficialLastName: | PARIS | ||||||||
| AuthorizedOfficialFirstName: | DAVIS | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9544211199 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 276891700 | 05 | FL | MEDICAID |