Provider Demographics
NPI:1659550705
Name:DIAGNOSTIC MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC MEDICAL IMAGING LLC
Other - Org Name:DIAGNOSTIC MEDICAL IMAGING LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-778-8882
Mailing Address - Street 1:7050 NW 4TH ST STE 204303
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2200
Mailing Address - Country:US
Mailing Address - Phone:754-778-8882
Mailing Address - Fax:754-778-8882
Practice Address - Street 1:7050 NW 4TH ST STE 303
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2247
Practice Address - Country:US
Practice Address - Phone:754-778-8882
Practice Address - Fax:954-703-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7983261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL745Medicare PIN