MEDICARE: NEURO IMAGING INSTITUTE II INC

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	:	1497704894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO IMAGING INSTITUTE II INC

Provider Business Mailing Address
First Line	:	2764 PELHAM PKWY
Second Line	:
City	:	PELHAM
State	:	AL
Zip	:	35124-1702
Country	:	US
Telephone Number	:	205-685-5075
Fax Number	:	205-994-7021

Provider Business Practice Location Address
First Line	:	270 N SYKES CREEK PKWY
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3492
Country	:	US
Telephone Number	:	321-454-7302
Fax Number	:	321-454-4675

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	DONNA L BURCH
Credential	:
Telephone Number	:	205-685-5075

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	01/07/2009

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