MEDICARE: SOUTH MIAMI 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HCC13209	OTHER	FL	AHCA

General Provider Information

NPI Number	:	1205497260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH MIAMI OPEN MRI LLC

Provider Business Mailing Address
First Line	:	6161 SUNSET DR STE A
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5045
Country	:	US
Telephone Number	:	305-665-4674
Fax Number	:	305-669-4674

Provider Business Practice Location Address
First Line	:	88 NE 168TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3410
Country	:	US
Telephone Number	:	305-665-4674
Fax Number	:	305-669-4674

Authorized Official
Title or Position	:	MANAGER
Name	:	ROLAND J GRASS
Credential	:
Telephone Number	:	305-665-4674

Provider Enumeration Date	:	06/21/2019
Last Update Date	:	04/02/2025

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