Provider Demographics
NPI:1336478718
Name:MOBILE DIAGNOSTIC IMAGING OF SOUTH FLORIDA INC
Entity Type:Organization
Organization Name:MOBILE DIAGNOSTIC IMAGING OF SOUTH FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1954-217-6232
Mailing Address - Street 1:2645 EXECUTIVE PARK DR STE 120
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3624
Mailing Address - Country:US
Mailing Address - Phone:954-217-6232
Mailing Address - Fax:305-485-3211
Practice Address - Street 1:2645 EXECUTIVE PARK DR STE 120
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3624
Practice Address - Country:US
Practice Address - Phone:954-217-6232
Practice Address - Fax:305-485-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile