| Entity Name: | PALMS WEST IMAGING, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 02 May 1990 (35 years ago) |
| Document Number: | L70125 |
| FEI/EIN Number | 650197524 |
| Address: | 11337 OKEECHOBEE BLVD, ROYAL PALM BEACH, FL, 33411, US |
| Mail Address: | 11337 OKEECHOBEE BLVD, ROYAL PALM BEACH, FL, 33411, US |
| ZIP code: | 33411 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700877602 | 2005-10-31 | 2020-08-22 | 11337 OKEECHOBEE BLVD, SUITE B, ROYAL PALM BEACH, FL, 334118732, US | 11337 OKEECHOBEE BLVD, SUITE B, ROYAL PALM BEACH, FL, 334118732, US | |||||||||||||||||||||||||
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| Phone | +1 561-795-5558 |
| Fax | 5617927300 |
Authorized person
| Name | DR. JONATHAN S HUBER |
| Role | MEDICAL DIRECTOR |
| Phone | 5617959150 |
Taxonomy
| Taxonomy Code | 261QM1200X - Magnetic Resonance Imaging (MRI) Clinic/Center |
| License Number | HCC1448 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS IDTF |
| Number | V2350 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CONROY KELLY | Agent | 12798 W. FOREST HILL BLVD., WELLINGTON, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| BANSAL RAJENDRA M | President | 11337 OKEECHOBEE BLVD, ROYAL PALM BEACH, FL |
| HANSEN ARTHUR | President | 11337 OKEECHOBEE BLVD, ROYAL PALM BEACH, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
