=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457405060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPEN MRI AND CT OF SOUTH MIAMI, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 01/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 NW 1ST AVE
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33444-2611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-272-4770
-----------------------------------------------------
Fax | 561-272-0811
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3733 PARK EAST DR SUITE 100
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-4338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-292-9998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | NANCY WESTRICH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-292-9998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------