Provider Demographics
NPI:1477725893
Name:MADRID, LLC
Entity Type:Organization
Organization Name:MADRID, LLC
Other - Org Name:FLORIDA OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIROSLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-623-3211
Mailing Address - Street 1:7201 N PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2517
Mailing Address - Country:US
Mailing Address - Phone:954-720-0903
Mailing Address - Fax:954-720-4583
Practice Address - Street 1:7201 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2517
Practice Address - Country:US
Practice Address - Phone:954-720-0903
Practice Address - Fax:954-720-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5165261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)