Provider Demographics
NPI:1598213746
Name:PINES IMAGING CENTER LLC
Entity Type:Organization
Organization Name:PINES IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GM
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN-A-SUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-530-8824
Mailing Address - Street 1:9696 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6246
Mailing Address - Country:US
Mailing Address - Phone:954-530-8824
Mailing Address - Fax:954-530-8819
Practice Address - Street 1:9696 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6246
Practice Address - Country:US
Practice Address - Phone:954-530-8824
Practice Address - Fax:954-530-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG16000010749OtherSTATE REGISTRATION NUMBER