Healthcare Provider Details

I. General information

NPI: 1669423356
Provider Name (Legal Business Name): MR SERVICES I LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 SHERIDAN ST
HOLLYWOOD FL
33021-3554
US

IV. Provider business mailing address

4310 SHERIDAN ST
HOLLYWOOD FL
33021-3554
US

V. Phone/Fax

Practice location:
  • Phone: 954-963-8177
  • Fax:
Mailing address:
  • Phone: 954-963-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK GANS
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-683-8177