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General NPI Number Information
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NPI Number | 1285882910
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA MOBILE OPEN MRI, LLC
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Dates
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Enumeration Date | 09/06/2008
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 4348 FOREST HILL BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-5718
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Country | US
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Telephone | 561-641-6093
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Fax | 561-641-6094
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Provider Business Mailing Address
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Address Line | 4348 FOREST HILL BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-5718
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Country | US
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Telephone | 561-641-6093
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Fax | 561-641-6094
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | FORREST ALLEN WRIGHT
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Credential | RT (R) (MR)
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Telephone | 305-360-3220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number | CRT54864
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License Number State | FL
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