| Entity Name: | PALMS WEST MRI, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 12 Jul 2000 (25 years ago) |
| Document Number: | L00000008261 |
| FEI/EIN Number | 651028973 |
| Address: | 2425 E COMMERCIAL BLVD, STE 101, fort lauderdale, FL, 33308, US |
| Mail Address: | 2425 E COMMERCIAL BLVD, STE 101, fort lauderdale, FL, 33308, US |
| ZIP code: | 33308 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871584771 | 2005-10-31 | 2014-10-01 | PO BOX 212738, ROYAL PALM BEACH, FL, 334212738, US | 701 S MAIN ST, BELLE GLADE, FL, 334304201, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 561-766-1300 |
| Fax | 5613187163 |
| Phone | +1 561-996-2000 |
| Fax | 5619962008 |
Authorized person
| Name | ARTHUR HANSEN |
| Role | OWNER |
| Phone | 5617661300 |
Taxonomy
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| License Number | HCC8896 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002891000 |
| State | FL |
| Issuer | BCBS |
| Number | V2507 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Ramos Christine | Agent | 2326 South Congress Avenue, West Palm Beach, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| HANSEN ARTHUR | Manager | 3461 Fairlane Farms Road, WELLINGTON, FL, 33414 |
| GHIRAGOSSIAN JORGE D | Manager | 3461 Fairlane Farms Road, WELLINGTON, FL, 33414 |
| Bansal Rajendra | Manager | 3461 Fairlane Farms Road, Wellington, FL, 33414 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000030817 | INDEPENDENT IMAGING | EXPIRED | 2011-03-28 | 2016-12-31 | No data | 701 S MAIN STREET, BELLE GLADE, FL, 33430 |
| G10000119143 | INDEPENDENT CARDIOLOGY IMAGES | EXPIRED | 2010-12-29 | 2015-12-31 | No data | 3347 SOUTH STATE ROAD 7 - SUITE 100, WELLINGTON, FL, 33449 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2015-08-28 | No data | CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS L01000004657. MERGER NUMBER 700000153967 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
