Healthcare Provider Details

I. General information

NPI: 1003069808
Provider Name (Legal Business Name): MIDTOWN IMAGING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18851 NE 29TH AVE SUITE 103
AVENTURA FL
33180-2808
US

IV. Provider business mailing address

18851 NE 29TH AVE SUITE 103
AVENTURA FL
33180-2808
US

V. Phone/Fax

Practice location:
  • Phone: 305-932-5554
  • Fax: 561-209-6377
Mailing address:
  • Phone: 305-932-5554
  • Fax: 561-209-6377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN G JOHNSON
Title or Position: CFO
Credential:
Phone: 561-697-3001