=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306965884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALMETTO OPEN MRI INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 08/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2150 WEST 68 ST SUITE #102
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-818-6868
-----------------------------------------------------
Fax | 305-818-6872
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2150 WEST 68 ST SUITE #102
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-818-6868
-----------------------------------------------------
Fax | 305-818-6872
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALEJANDRO R XIQUES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-448-6841
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------