MEDICARE: OMEGA MEDICAL DIAGNOSTIC 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	261Q00000X	Clinic/Center	HCC5548	FL

General Provider Information

NPI Number	:	1134169923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMEGA MEDICAL DIAGNOSTIC INC

Provider Business Mailing Address
First Line	:	5923 SW 8TH ST
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5037
Country	:	US
Telephone Number	:	305-267-8687
Fax Number	:	305-267-8688

Provider Business Practice Location Address
First Line	:	5923 SW 8TH ST
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5037
Country	:	US
Telephone Number	:	305-267-8687
Fax Number	:	305-267-8688

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MARIA JULIA PALMERO
Credential	:
Telephone Number	:	305-267-8687

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	01/17/2008

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