Provider Demographics
NPI:1114056579
Name:SOUTH BROWARD MRI CENTER, LTD
Entity Type:Organization
Organization Name:SOUTH BROWARD MRI CENTER, LTD
Other - Org Name:MRI OF SOUTH BROWARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SHICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-962-4700
Mailing Address - Street 1:3500 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6809
Mailing Address - Country:US
Mailing Address - Phone:954-983-6488
Mailing Address - Fax:
Practice Address - Street 1:3500 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6809
Practice Address - Country:US
Practice Address - Phone:954-983-6488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33175Medicare ID - Type Unspecified