Healthcare Provider Details

I. General information

NPI: 1235237355
Provider Name (Legal Business Name): MRI SCAN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3122 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33308-4327
US

IV. Provider business mailing address

3122 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33308-4327
US

V. Phone/Fax

Practice location:
  • Phone: 954-772-8000
  • Fax: 954-776-6356
Mailing address:
  • Phone: 954-772-8000
  • Fax: 954-776-6356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number2790004383
License Number StateFL

VIII. Authorized Official

Name: LAURA KASSA
Title or Position: COMPLIANCE OFFICER
Credential: RT (R)(CT)(MR)
Phone: 904-640-9129