MEDICARE: FT. MYERS MRI, LLC

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		FL

General Provider Information

NPI Number	:	1801396742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FT. MYERS MRI, LLC

Provider Business Mailing Address
First Line	:	6300 CORPORATE CT STE 101
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3513
Country	:	US
Telephone Number	:	239-689-3695
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 CORPORATE CT STE 101
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3513
Country	:	US
Telephone Number	:	239-689-3695
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	MODESTO SANCHEZ-TORRES
Credential	:	MD
Telephone Number	:	239-689-3695

Provider Enumeration Date	:	02/16/2018
Last Update Date	:	02/16/2018

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