MEDICARE: OPEN MRI OF SW FLORIDA INC

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	HCC7684	FL

General Provider Information

NPI Number	:	1649474735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MRI OF SW FLORIDA INC

Provider Business Mailing Address
First Line	:	12995 S CLEVELAND AVE
Second Line	:	182
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3890
Country	:	US
Telephone Number	:	239-936-3332
Fax Number	:	239-936-9557

Provider Business Practice Location Address
First Line	:	12995 S CLEVELAND AVE
Second Line	:	182
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3890
Country	:	US
Telephone Number	:	239-936-3332
Fax Number	:	239-936-9557

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LEANDRO A FELIZ
Credential	:
Telephone Number	:	239-936-3332

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	01/31/2008

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