Provider Demographics
NPI:1174022958
Name:MRI RADIOLOGY NETWORK PA
Entity Type:Organization
Organization Name:MRI RADIOLOGY NETWORK PA
Other - Org Name:UNIVERSITY MRI POMPANO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONZAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-826-1202
Mailing Address - Street 1:3848 FAU BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6437
Mailing Address - Country:US
Mailing Address - Phone:561-826-1202
Mailing Address - Fax:
Practice Address - Street 1:50 E SAMPLE RD STE 100
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3552
Practice Address - Country:US
Practice Address - Phone:561-362-9191
Practice Address - Fax:561-394-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56655261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology