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General NPI Number Information
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NPI Number | 1366641003
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Entity Type | Organization
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Legal Business Name | HIGH DEFINITION MOBILE MRI, INC
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 990 S CONGRESS AVE STE 1
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City | DELRAY BEACH
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State | FL
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Zip | 33445-4653
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Country | US
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Telephone | 786-319-2474
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Fax |
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Provider Business Mailing Address
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Address Line | 8927 HYPOLUXO RD STE A4
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City | LAKE WORTH
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State | FL
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Zip | 33467-5249
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MRI TECH/PRESIDENT
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Name | MR. EDVARD DESSALINES
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Credential | CRT
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Telephone | 561-577-9019
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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 | HCC5826
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License Number State | FL
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