Provider Demographics
NPI:1447237722
Name:PRESGAR IMAGING OF CMI NORTH LC
Entity Type:Organization
Organization Name:PRESGAR IMAGING OF CMI NORTH LC
Other - Org Name:CENTRAL MAGNETIC IMAGING NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:VADILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-947-1415
Mailing Address - Street 1:1860 NE MIAMI GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5036
Mailing Address - Country:US
Mailing Address - Phone:305-947-1416
Mailing Address - Fax:305-347-1569
Practice Address - Street 1:1860 NE MIAMI GARDENS DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-5036
Practice Address - Country:US
Practice Address - Phone:305-947-1416
Practice Address - Fax:305-947-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9937261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3087AMedicare ID - Type Unspecified