=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073768313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIAMI X-RAY CENTERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2008
-----------------------------------------------------
Last Update Date | 12/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2128 W FLAGLER ST SUITE 201
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33135-1687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-644-0303
-----------------------------------------------------
Fax | 305-644-0043
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2128 W FLAGLER ST SUITE 201
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33135-1687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-644-0303
-----------------------------------------------------
Fax | 305-644-0043
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOHN ROMANO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-644-0303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | MM21301
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------