MEDICARE: AMERICAN HEALTH IMAGING MW, 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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1386352292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HEALTH IMAGING MW, LLC

Provider Business Mailing Address
First Line	:	15712 SW 41ST ST STE 16
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33331-1538
Country	:	US
Telephone Number	:	954-919-5005
Fax Number	:	800-400-6972

Provider Business Practice Location Address
First Line	:	10126 WOODFIELD LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2923
Country	:	US
Telephone Number	:	954-919-5005
Fax Number	:	800-400-6972

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRIS MARTIN
Credential	:
Telephone Number	:	954-919-5005

Provider Enumeration Date	:	11/09/2022
Last Update Date	:	11/09/2022

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