MEDICARE: PRESGAR IMAGING OF CMI NORTH LC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	HCC9937	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447237722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESGAR IMAGING OF CMI NORTH LC

Provider Business Mailing Address
First Line	:	1860 NE MIAMI GARDENS DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-5036
Country	:	US
Telephone Number	:	305-947-1416
Fax Number	:	305-347-1569

Provider Business Practice Location Address
First Line	:	1860 NE MIAMI GARDENS DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-5036
Country	:	US
Telephone Number	:	305-947-1416
Fax Number	:	305-947-1569

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS/OWNER
Name	:	MANUEL J VADILLO
Credential	:
Telephone Number	:	305-947-1415

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	10/22/2021

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