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Organization
WEST BOYNTON BEACH OPEN IMAGING CENTER LLC
Active
Organization
WEST BOYNTON BEACH OPEN IMAGING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAVELLE R HARDIN (COORDINATOR)
(615) 344-8203
Entity
Organization
Contact information
Practice address
10151 ENTERPRISE CENTER BLVD, SUITE 109, BOYNTON BEACH, FL 33437-3759
(561) 752-5050
(561) 364-5606
Mailing address
10151 ENTERPRISE CENTER BLVD, SUITE 109, BOYNTON BEACH, FL 33437-3759
(561) 752-5050
(561) 346-5606
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000260600
—
FL
01
—
V3267
BCBS
FL
Enumeration date
02/12/2008
Last updated
02/20/2010
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