MEDICARE: MED PRO IMAGING

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	261Q00000X	Clinic/Center	H63883	FL

General Provider Information

NPI Number	:	1891808606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED PRO IMAGING

Provider Business Mailing Address
First Line	:	7050 NW 4TH ST
Second Line	:	SUITE # 202
City	:	PLANTATION
State	:	FL
Zip	:	33317-2247
Country	:	US
Telephone Number	:	954-791-9729
Fax Number	:	954-791-9724

Provider Business Practice Location Address
First Line	:	7050 NW 4TH ST
Second Line	:	SUITE # 202
City	:	PLANTATION
State	:	FL
Zip	:	33317-2247
Country	:	US
Telephone Number	:	954-791-9729
Fax Number	:	954-791-9724

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. IRIS MARIN
Credential	:
Telephone Number	:	954-791-9729

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	05/28/2008

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Directions to “MED PRO IMAGING ” Practice Location

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