Provider Demographics
NPI:1831296060
Name:HALLANDALE OPEN MRI, LLC
Entity Type:Organization
Organization Name:HALLANDALE OPEN MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:VIRGILIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-983-8382
Mailing Address - Street 1:3101 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5160
Mailing Address - Country:US
Mailing Address - Phone:954-983-8382
Mailing Address - Fax:954-983-8665
Practice Address - Street 1:3101 W HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009-5160
Practice Address - Country:US
Practice Address - Phone:954-983-8382
Practice Address - Fax:954-983-8665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5496261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL386256OtherJCAHO
FLV2608OtherBCBS-OUT OF NETWORK
FLHCC5496OtherAHCA
FL386256OtherJCAHO