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General NPI Number Information
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NPI Number | 1467962209
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Entity Type | Organization
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Legal Business Name | PLANTATION OPEN MRI, LLC
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 4331 N FEDERAL HWY STE 200
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-5252
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Country | US
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Telephone | 754-208-3310
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Fax |
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Provider Business Mailing Address
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Address Line | 11011 SHERIDAN ST STE 101
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City | HOLLYWOOD
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State | FL
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Zip | 33026-1501
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Country | US
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Telephone | 754-208-3310
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BARBARA DOMINO
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Credential |
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Telephone | 754-208-3310
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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 | HCC8364
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License Number State | FL
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