Provider Demographics
NPI:1114989209
Name:OPEN MAGNETIC IMAGING OF PEMBROKE PINES LTD
Entity Type:Organization
Organization Name:OPEN MAGNETIC IMAGING OF PEMBROKE PINES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:DENOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-343-4065
Mailing Address - Street 1:2200 N. COMMERCE PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326
Mailing Address - Country:US
Mailing Address - Phone:954-888-6411
Mailing Address - Fax:954-888-6414
Practice Address - Street 1:330 S. FLAMINGO ROAD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027
Practice Address - Country:US
Practice Address - Phone:954-438-8887
Practice Address - Fax:954-438-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3906261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E1786Medicare PIN