MEDICARE: JAY DIAGNOSTIC & REHAB. CENTER

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	261QR0200X	Radiology Clinic/Center	BMO65089	FL

General Provider Information

NPI Number	:	1912287269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY DIAGNOSTIC & REHAB. CENTER

Provider Business Mailing Address
First Line	:	742 E 10TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-3636
Country	:	US
Telephone Number	:	786-536-5358
Fax Number	:	786-536-5484

Provider Business Practice Location Address
First Line	:	742 E 10TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-3636
Country	:	US
Telephone Number	:	786-536-5358
Fax Number	:	786-536-5484

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JUDITH MERAS
Credential	:
Telephone Number	:	786-536-5358

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	08/18/2011

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