Healthcare Provider Details

I. General information

NPI: 1518929702
Provider Name (Legal Business Name): OPEN MAGNETIC IMAGING OF WEST BOCA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20401 STATE ROAD 7 SUITE G-8
BOCA RATON FL
33498
US

IV. Provider business mailing address

2200 N. COMMERCE PARKWAY SUITE 100
WESTON FL
33326
US

V. Phone/Fax

Practice location:
  • Phone: 561-482-5559
  • Fax: 561-482-4417
Mailing address:
  • Phone: 954-888-6411
  • Fax: 954-888-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberHCC3912
License Number StateFL

VIII. Authorized Official

Name: FRANK DENOUN
Title or Position: COMPTROLLER
Credential:
Phone: 954-343-4065