Provider Demographics
NPI:1598806846
Name:NON-INVASIVE DIAGNOSTIC IMAGING SERVICE CORP
Entity Type:Organization
Organization Name:NON-INVASIVE DIAGNOSTIC IMAGING SERVICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-559-1190
Mailing Address - Street 1:13055 SW 42ND ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3406
Mailing Address - Country:US
Mailing Address - Phone:305-412-0038
Mailing Address - Fax:305-412-0038
Practice Address - Street 1:13055 SW 42ND ST
Practice Address - Street 2:SUITE 206
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3406
Practice Address - Country:US
Practice Address - Phone:305-412-0038
Practice Address - Fax:305-412-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376989500Medicaid
FLE1841Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER