MEDICARE: OMI CT OF FORT LAUDERDALE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1083676175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMI CT OF FORT LAUDERDALE INC

Provider Business Mailing Address
First Line	:	2200 N COMMERCE PKWY
Second Line	:	SUITE 100
City	:	WESTON
State	:	FL
Zip	:	33326
Country	:	US
Telephone Number	:	954-888-6411
Fax Number	:	954-888-6414

Provider Business Practice Location Address
First Line	:	841 E COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33334
Country	:	US
Telephone Number	:	954-229-3998
Fax Number	:	954-229-1903

Authorized Official
Title or Position	:	CFO
Name	:	ALAN BABITZ
Credential	:
Telephone Number	:	954-888-6411

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	04/08/2008

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