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NPI Code Detail

MEDICARE: FOUNTAIN IMAGING OF NORTH MIAMI BEACH,LLC

MEDICARE: FOUNTAIN IMAGING OF NORTH MIAMI BEACH,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
1261QM1200XMagnetic Resonance Imaging (MRI) Clinic/CenterHCC7170FL

General Provider Information

NPI Number : 1457417156
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOUNTAIN IMAGING OF NORTH MIAMI BEACH,LLC
Provider Business Mailing Address
First Line : 1 NE 167TH ST
Second Line :
City : NORTH MIAMI BEACH
State : FL
Zip : 33162-3402
Country : US
Telephone Number : 305-770-4343
Fax Number : 305-770-4373
Provider Business Practice Location Address
First Line : 1 NE 167TH ST
Second Line :
City : NORTH MIAMI BEACH
State : FL
Zip : 33162-3402
Country : US
Telephone Number : 305-770-4343
Fax Number : 305-770-4373
Authorized Official
Title or Position : ADMINISTRATOR
Name : MISS KRISTI LYNN HEBERT
Credential :
Telephone Number : 305-770-4343
Provider Enumeration Date : 12/28/2006
Last Update Date : 08/22/2020

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