Provider Demographics
NPI:1053689877
Name:MILLENIUM HEALTHCARE DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:MILLENIUM HEALTHCARE DIAGNOSTICS, INC.
Other - Org Name:FLORIDA OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIROSLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-623-3211
Mailing Address - Street 1:2929 S CARAWAY RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7307
Mailing Address - Country:US
Mailing Address - Phone:870-275-7749
Mailing Address - Fax:870-275-6073
Practice Address - Street 1:7201 NW 88TH AVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2517
Practice Address - Country:US
Practice Address - Phone:954-720-0903
Practice Address - Fax:954-720-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5165261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)