Healthcare Provider Details

I. General information

NPI: 1760579411
Provider Name (Legal Business Name): CENTRAL FLORIDA OPEN MRI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 US HWY 27 NORTH
SEBRING FL
33870-1626
US

IV. Provider business mailing address

2821 US HWY 27 NORTH
SEBRING FL
33870-1626
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-0938
  • Fax: 863-402-0946
Mailing address:
  • Phone: 863-402-0938
  • Fax: 863-402-0946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FABIO OLIVEROS
Title or Position: PRESIDENT
Credential:
Phone: 863-385-2606