Provider Demographics
NPI:1205497260
Name:SOUTH MIAMI OPEN MRI LLC
Entity type:Organization
Organization Name:SOUTH MIAMI OPEN MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-665-4674
Mailing Address - Street 1:6161 SUNSET DR STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5045
Mailing Address - Country:US
Mailing Address - Phone:305-665-4674
Mailing Address - Fax:305-669-4674
Practice Address - Street 1:88 NE 168TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3410
Practice Address - Country:US
Practice Address - Phone:305-665-4674
Practice Address - Fax:305-669-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC13209OtherAHCA