Provider Demographics
NPI:1659638989
Name:PROFESSIONAL DIAGNOSTIC READING MRI INC
Entity Type:Organization
Organization Name:PROFESSIONAL DIAGNOSTIC READING MRI INC
Other - Org Name:PROFESSIONSL DIAGNOSTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TUREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-400-5752
Mailing Address - Street 1:4100 N POWERLINE RD STE G2
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3040
Mailing Address - Country:US
Mailing Address - Phone:954-858-5999
Mailing Address - Fax:
Practice Address - Street 1:4100 N POWERLINE RD STE G2
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33073-3040
Practice Address - Country:US
Practice Address - Phone:954-858-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC 9391OtherAHCA