Provider Demographics
NPI:1467962209
Name:PLANTATION OPEN MRI, LLC
Entity Type:Organization
Organization Name:PLANTATION OPEN MRI, LLC
Other - Org Name:POM MRI & IMAGING CENTER OF FORT LAUDERDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-208-3310
Mailing Address - Street 1:11011 SHERIDAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1501
Mailing Address - Country:US
Mailing Address - Phone:754-208-3310
Mailing Address - Fax:
Practice Address - Street 1:4331 N FEDERAL HWY STE 200
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5252
Practice Address - Country:US
Practice Address - Phone:754-208-3310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLANTATION OPEN MRI, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8364261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)