Provider Demographics
NPI:1245227529
Name:PINNACLE IMAGING CENTER LLC
Entity Type:Organization
Organization Name:PINNACLE IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MM
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:H
Authorized Official - Last Name:JAAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGING MEMBER
Authorized Official - Phone:305-642-7388
Mailing Address - Street 1:2390 NW 7TH ST
Mailing Address - Street 2:#103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3226
Mailing Address - Country:US
Mailing Address - Phone:305-642-7388
Mailing Address - Fax:305-642-4988
Practice Address - Street 1:2390 NW 7TH ST
Practice Address - Street 2:#103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3226
Practice Address - Country:US
Practice Address - Phone:305-642-7388
Practice Address - Fax:305-642-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC61532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U5131Medicare ID - Type Unspecified