Provider Demographics
NPI:1912936105
Name:PRO-ECHO INC
Entity Type:Organization
Organization Name:PRO-ECHO INC
Other - Org Name:PRO-ECHO DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:EBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-532-7460
Mailing Address - Street 1:PO BOX 546436
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-0436
Mailing Address - Country:US
Mailing Address - Phone:305-532-7460
Mailing Address - Fax:305-532-7648
Practice Address - Street 1:300 ARTHUR GODFREY ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3627
Practice Address - Country:US
Practice Address - Phone:305-532-7460
Practice Address - Fax:305-532-7648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4839261QR0200X, 261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1701Medicare UPIN