Provider Demographics
NPI:1922129121
Name:SOUTHEAST MRI LLC
Entity Type:Organization
Organization Name:SOUTHEAST MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-817-9402
Mailing Address - Street 1:2295 NW CORPORATE BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7323
Mailing Address - Country:US
Mailing Address - Phone:561-241-1971
Mailing Address - Fax:561-241-3969
Practice Address - Street 1:1950 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1003
Practice Address - Country:US
Practice Address - Phone:954-784-6292
Practice Address - Fax:954-784-6229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID NUMBER