Provider Demographics
NPI:1639579972
Name:ADVANCE MRI
Entity Type:Organization
Organization Name:ADVANCE MRI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:SR
Authorized Official - Phone:305-471-4593
Mailing Address - Street 1:8900 SW 107TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1451
Mailing Address - Country:US
Mailing Address - Phone:305-271-0570
Mailing Address - Fax:
Practice Address - Street 1:8900 SW 107TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1451
Practice Address - Country:US
Practice Address - Phone:305-271-0570
Practice Address - Fax:305-271-0520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STAT DIAGNOSTICS IMAGING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology