Provider Demographics
NPI:1164676722
Name:PLANTATION OPEN MRI, LLC
Entity Type:Organization
Organization Name:PLANTATION OPEN MRI, LLC
Other - Org Name:POM MRI & IMAGING CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R) (MR)
Authorized Official - Phone:954-900-2020
Mailing Address - Street 1:11011 SHERIDAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1501
Mailing Address - Country:US
Mailing Address - Phone:954-239-7466
Mailing Address - Fax:954-200-8725
Practice Address - Street 1:4331 N FEDERAL HWY STE 200
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5252
Practice Address - Country:US
Practice Address - Phone:954-900-2020
Practice Address - Fax:954-343-1855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL393202471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty