Provider Demographics
NPI:1366641003
Name:HIGH DEFINITION MOBILE MRI, INC
Entity Type:Organization
Organization Name:HIGH DEFINITION MOBILE MRI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MRI TECH/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDVARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DESSALINES
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:561-577-9019
Mailing Address - Street 1:8927 HYPOLUXO RD STE A4
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:990 S CONGRESS AVE STE 1
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4653
Practice Address - Country:US
Practice Address - Phone:786-319-2474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5826261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)