MEDICARE: SOUTH FLORIDA MOBILE 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	CRT54864	FL

General Provider Information

NPI Number	:	1285882910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA MOBILE OPEN MRI, LLC

Provider Business Mailing Address
First Line	:	4348 FOREST HILL BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5718
Country	:	US
Telephone Number	:	561-641-6093
Fax Number	:	561-641-6094

Provider Business Practice Location Address
First Line	:	4348 FOREST HILL BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5718
Country	:	US
Telephone Number	:	561-641-6093
Fax Number	:	561-641-6094

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	FORREST ALLEN WRIGHT
Credential	:	RT (R) (MR)
Telephone Number	:	305-360-3220

Provider Enumeration Date	:	09/06/2008
Last Update Date	:	10/28/2016

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