Provider Demographics
NPI:1528187812
Name:PRO-ECHO INC
Entity Type:Organization
Organization Name:PRO-ECHO INC
Other - Org Name:PRO-ECHO DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:EBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-532-7460
Mailing Address - Street 1:PO BOX 546436
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-0436
Mailing Address - Country:US
Mailing Address - Phone:305-532-7460
Mailing Address - Fax:305-532-7648
Practice Address - Street 1:907 ALTON RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-5203
Practice Address - Country:US
Practice Address - Phone:305-673-4247
Practice Address - Fax:305-532-7648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC12014261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1701CMedicare UPIN