Provider Demographics
NPI:1760190656
Name:AMERICAN HEALTH IMAGING MW, LLC
Entity Type:Organization
Organization Name:AMERICAN HEALTH IMAGING MW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-919-5005
Mailing Address - Street 1:15712 SW 41ST ST STE 16
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1538
Mailing Address - Country:US
Mailing Address - Phone:954-919-5005
Mailing Address - Fax:800-400-6972
Practice Address - Street 1:10204 LANTERN RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9705
Practice Address - Country:US
Practice Address - Phone:317-909-8110
Practice Address - Fax:800-400-6972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory