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General NPI Number Information
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NPI Number | 1144992025
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Entity Type | Organization
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Legal Business Name | EXCEPTIONAL IMAGING CENTER
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 8910 MIRAMAR PKWY STE 109
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City | MIRAMAR
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State | FL
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Zip | 33025-4187
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Country | US
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Telephone | 305-801-3336
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Fax | 305-363-8446
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Provider Business Mailing Address
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Address Line | 8910 MIRAMAR PKWY STE 109
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City | MIRAMAR
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State | FL
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Zip | 33025-4187
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Country | US
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Telephone | 305-801-3336
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Fax | 305-363-8446
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Authorized Official
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Title or Position | RADIOLOGIST
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Name | LEDEANNA MCCOY
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Credential | MD
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Telephone | 305-801-3336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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