Provider Demographics
NPI:1972872562
Name:IMIS SURGERY INJURIES OF S.FLORIDA PLLC
Entity Type:Organization
Organization Name:IMIS SURGERY INJURIES OF S.FLORIDA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-626-0063
Mailing Address - Street 1:1100 W OAKLAND PARK BLVD
Mailing Address - Street 2:UNIT 3
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1612
Mailing Address - Country:US
Mailing Address - Phone:954-626-0063
Mailing Address - Fax:888-691-6040
Practice Address - Street 1:1100 W OAKLAND PARK BLVD
Practice Address - Street 2:UNIT 3
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-1612
Practice Address - Country:US
Practice Address - Phone:954-626-0063
Practice Address - Fax:888-691-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty