MEDICARE: VIRTUAL IMAGING SERVICES 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	302R00000X	Health Maintenance Organization	HCC8443	FL

General Provider Information

NPI Number	:	1558501569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRTUAL IMAGING SERVICES INC

Provider Business Mailing Address
First Line	:	7101 SW 99TH AVE
Second Line	:	SUITE 106
City	:	MIAMI
State	:	FL
Zip	:	33173-4661
Country	:	US
Telephone Number	:	305-596-9992
Fax Number	:	305-596-0942

Provider Business Practice Location Address
First Line	:	3320 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5241
Country	:	US
Telephone Number	:	305-863-1755
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JUAN PUIG
Credential	:
Telephone Number	:	305-596-9992

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	08/08/2013

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