Provider Demographics
NPI:1669423356
Name:MR SERVICES I LLC
Entity type:Organization
Organization Name:MR SERVICES I LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-683-8177
Mailing Address - Street 1:4310 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3554
Mailing Address - Country:US
Mailing Address - Phone:954-963-8177
Mailing Address - Fax:
Practice Address - Street 1:4310 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3554
Practice Address - Country:US
Practice Address - Phone:954-963-8177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2085R0202XOtherMRI
FL2471C3401XOtherRADIOLOGY