MEDICARE: PLANTATION OPEN MRI, LLC

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	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist	39320	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164676722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLANTATION OPEN MRI, LLC

Provider Business Mailing Address
First Line	:	11011 SHERIDAN ST STE 101
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-1501
Country	:	US
Telephone Number	:	954-239-7466
Fax Number	:	954-200-8725

Provider Business Practice Location Address
First Line	:	4331 N FEDERAL HWY STE 200
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5252
Country	:	US
Telephone Number	:	954-900-2020
Fax Number	:	954-343-1855

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANDREW MICHAEL BYERS
Credential	:	R.T. (R) (MR)
Telephone Number	:	954-900-2020

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	11/21/2018

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