Healthcare Provider Details

I. General information

NPI: 1528373040
Provider Name (Legal Business Name): 1ST OPEN MRI.LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 SW 27TH AVE
MIAMI FL
33145-1234
US

IV. Provider business mailing address

1455 SW 27TH AVE
MIAMI FL
33145-1234
US

V. Phone/Fax

Practice location:
  • Phone: 305-541-9595
  • Fax: 305-541-9882
Mailing address:
  • Phone: 305-541-9595
  • Fax: 305-541-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberCRT45704
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License NumberCRT45704
License Number StateFL

VIII. Authorized Official

Name: LUIS ACOSTA
Title or Position: PRESIDENT
Credential:
Phone: 305-984-5388