Provider Demographics
NPI:1497704894
Name:NEURO IMAGING INSTITUTE II INC
Entity Type:Organization
Organization Name:NEURO IMAGING INSTITUTE II INC
Other - Org Name:DIAGNOSTIC HEALTH, MERRITT ISLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-685-5075
Mailing Address - Street 1:2764 PELHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1702
Mailing Address - Country:US
Mailing Address - Phone:205-685-5075
Mailing Address - Fax:205-994-7021
Practice Address - Street 1:270 N SYKES CREEK PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3492
Practice Address - Country:US
Practice Address - Phone:321-454-7302
Practice Address - Fax:321-454-4675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1240Medicare PIN