Provider Demographics
NPI:1891808606
Name:MED PRO IMAGING
Entity Type:Organization
Organization Name:MED PRO IMAGING
Other - Org Name:WEST BROWARD X-RAY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-791-9729
Mailing Address - Street 1:7050 NW 4TH ST
Mailing Address - Street 2:SUITE # 202
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2247
Mailing Address - Country:US
Mailing Address - Phone:954-791-9729
Mailing Address - Fax:954-791-9724
Practice Address - Street 1:7050 NW 4TH ST
Practice Address - Street 2:SUITE # 202
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2247
Practice Address - Country:US
Practice Address - Phone:954-791-9729
Practice Address - Fax:954-791-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLH63883261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center