Provider Demographics
NPI: | 1427399260 |
---|---|
Name: | PROFESSIONAL DIAGNOSTICS MRI READING INC |
Entity Type: | Organization |
Organization Name: | PROFESSIONAL DIAGNOSTICS MRI READING INC |
Other - Org Name: | PDR IMAGING |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | MICHELLE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MOTHERSIL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 561-616-9095 |
Mailing Address - Street 1: | 4100 N POWERLINE RD |
Mailing Address - Street 2: | SUITE G2 |
Mailing Address - City: | POMPANO BEACH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33073-3083 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-858-5999 |
Mailing Address - Fax: | 954-858-5354 |
Practice Address - Street 1: | 4100 N POWERLINE RD |
Practice Address - Street 2: | SUITE G2 |
Practice Address - City: | POMPANO BEACH |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33073-3083 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-858-5999 |
Practice Address - Fax: | 954-858-5354 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-03-04 |
Last Update Date: | 2013-03-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 291U00000X | Laboratories | Clinical Medical Laboratory |