Provider Demographics
NPI:1871584771
Name:PALMS WEST MRI, LLC
Entity type:Organization
Organization Name:PALMS WEST MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-766-1300
Mailing Address - Street 1:PO BOX 212738
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33421-2738
Mailing Address - Country:US
Mailing Address - Phone:561-766-1300
Mailing Address - Fax:561-318-7163
Practice Address - Street 1:701 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-4201
Practice Address - Country:US
Practice Address - Phone:561-996-2000
Practice Address - Fax:561-996-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8896261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002891000Medicaid
FLV2507OtherBCBS
FLV2507OtherBCBS