MEDICARE: CARDIAC MOBILE IMAGING 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	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1831389576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIAC MOBILE IMAGING INC

Provider Business Mailing Address
First Line	:	1599 SW 30TH AVE
Second Line	:	SUITE 5
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-9052
Country	:	US
Telephone Number	:	561-244-6111
Fax Number	:	561-880-6877

Provider Business Practice Location Address
First Line	:	1599 SW 30TH AVE
Second Line	:	SUITE 5
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-9052
Country	:	US
Telephone Number	:	561-244-6111
Fax Number	:	561-880-6877

Authorized Official
Title or Position	:	OWNER
Name	:	ADAM ADACHE
Credential	:
Telephone Number	:	561-244-6111

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	07/30/2007

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