Provider Demographics
NPI:1497732788
Name:PRESGAR IMAGING OF CMI SOUTH LC
Entity Type:Organization
Organization Name:PRESGAR IMAGING OF CMI SOUTH LC
Other - Org Name:CENTRAL MAGNETIC IMAGING SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-342-2363
Mailing Address - Street 1:PO BOX 1505
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33780-1505
Mailing Address - Country:US
Mailing Address - Phone:727-342-2363
Mailing Address - Fax:727-342-0025
Practice Address - Street 1:4860 SW 72ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5526
Practice Address - Country:US
Practice Address - Phone:305-663-2800
Practice Address - Fax:305-662-3881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7367261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL470001596OtherRAILROAD MEDICARE
FL470001596OtherRAILROAD MEDICARE