Provider Demographics
NPI: | 1134471048 |
---|---|
Name: | EXPRESS RADIOLOGY CORP |
Entity Type: | Organization |
Organization Name: | EXPRESS RADIOLOGY CORP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PD |
Authorized Official - Prefix: | |
Authorized Official - First Name: | YOSLAINE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | VALEDON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 786-414-3232 |
Mailing Address - Street 1: | 6095 NW 72ND AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33166-3737 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 786-414-3232 |
Mailing Address - Fax: | 305-885-1728 |
Practice Address - Street 1: | 6095 NW 72ND AVE |
Practice Address - Street 2: | |
Practice Address - City: | MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33166-3737 |
Practice Address - Country: | US |
Practice Address - Phone: | 786-414-3232 |
Practice Address - Fax: | 305-885-1728 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-10-03 |
Last Update Date: | 2012-10-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QR0200X | Ambulatory Health Care Facilities | Clinic/Center | Radiology | Group - Single Specialty |
No | 171R00000X | Other Service Providers | Interpreter | Group - Single Specialty |