Organization
DESTIN REGIONAL IMAGING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHUN CHEN MD (VICE PRESIDENT)
(850) 278-3556
Entity
Organization
Contact information
Practice address
75 ORIGINS MAIN ST STE 201, WATERSOUND, FL 32461-8647
(850) 278-3556
Mailing address
PO BOX 1977, INDIANAPOLIS, IN 46206-1977
(855) 410-3201
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00871
BC OF FLORIDA
—
Enumeration date
05/27/2022
Last updated
05/27/2022
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