Provider Demographics
NPI:1801396742
Name:FT. MYERS MRI, LLC
Entity Type:Organization
Organization Name:FT. MYERS MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MODESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ-TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-689-3695
Mailing Address - Street 1:6300 CORPORATE CT STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3513
Mailing Address - Country:US
Mailing Address - Phone:239-689-3695
Mailing Address - Fax:
Practice Address - Street 1:6300 CORPORATE CT STE 101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3513
Practice Address - Country:US
Practice Address - Phone:239-689-3695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)