Provider Demographics
NPI:1699824888
Name:HIALEAH IMAGING CORP
Entity Type:Organization
Organization Name:HIALEAH IMAGING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-819-0004
Mailing Address - Street 1:1681 W 37TH ST # 18-19
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4651
Mailing Address - Country:US
Mailing Address - Phone:305-819-0004
Mailing Address - Fax:305-819-3727
Practice Address - Street 1:1681 W 37TH ST # 18-19
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4651
Practice Address - Country:US
Practice Address - Phone:305-819-0004
Practice Address - Fax:305-819-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5186261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255270100Medicaid
FL33733OtherBC & BS OF FLORIDA
FL255270100Medicaid