Provider Demographics
NPI:1184657900
Name:SOUTHERN IMAGING ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SOUTHERN IMAGING ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HYPPOLITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-724-5191
Mailing Address - Street 1:6736 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4013
Mailing Address - Country:US
Mailing Address - Phone:954-724-5791
Mailing Address - Fax:954-724-5141
Practice Address - Street 1:6736 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4013
Practice Address - Country:US
Practice Address - Phone:954-724-5791
Practice Address - Fax:954-724-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6452261QM1200X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology