Provider Demographics
NPI:1275094203
Name:WOMEN'S IMAGING INSTITUTE, LLC
Entity Type:Organization
Organization Name:WOMEN'S IMAGING INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRIYANKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-998-1887
Mailing Address - Street 1:8930 W STATE ROAD 84 STE 124
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4456
Mailing Address - Country:US
Mailing Address - Phone:954-998-1887
Mailing Address - Fax:251-235-8378
Practice Address - Street 1:8397 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7307
Practice Address - Country:US
Practice Address - Phone:954-998-1887
Practice Address - Fax:251-235-8378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-31
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME118896OtherMEDICAL LICENSE