Provider Demographics
NPI:1568565430
Name:RADIOLOGY CONSULTANTS OF HOLLYWOOD INC
Entity Type:Organization
Organization Name:RADIOLOGY CONSULTANTS OF HOLLYWOOD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRNJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-612-7502
Mailing Address - Street 1:210 S FEDERAL HWY STE 403
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6811
Mailing Address - Country:US
Mailing Address - Phone:954-929-3449
Mailing Address - Fax:954-929-2001
Practice Address - Street 1:210 S FEDERAL HWY FL 2
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6811
Practice Address - Country:US
Practice Address - Phone:954-927-1776
Practice Address - Fax:954-927-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20137261QM1200X
261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057487202Medicaid
FLD60302Medicare UPIN
FL93040ZMedicare ID - Type Unspecified