Provider Demographics
NPI:1376716530
Name:ADVANCED MOLECULAR IMAGING OF FLORIDA LLC
Entity Type:Organization
Organization Name:ADVANCED MOLECULAR IMAGING OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-557-8408
Mailing Address - Street 1:2650 N MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6350
Mailing Address - Country:US
Mailing Address - Phone:954-557-8408
Mailing Address - Fax:
Practice Address - Street 1:2650 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6350
Practice Address - Country:US
Practice Address - Phone:954-557-8408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME595482085B0100X, 2085D0003X, 2085R0202X, 261Q00000X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center