MEDICARE: AURORA BREAST MRI OF SARASOTA 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

General Provider Information

NPI Number	:	1659558302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURORA BREAST MRI OF SARASOTA LLC

Provider Business Mailing Address
First Line	:	39 HIGH ST
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-2637
Country	:	US
Telephone Number	:	978-975-7530
Fax Number	:	978-975-3181

Provider Business Practice Location Address
First Line	:	2415 UNIVERSITY PARKWAY
Second Line	:	UNIVERSITY HEALTH PARK III SUITE 219
City	:	SARASOTA
State	:	FL
Zip	:	34243-2809
Country	:	US
Telephone Number	:	979-975-7530
Fax Number	:

Authorized Official
Title or Position	:	CLINIC ADMINISTRATOR
Name	:	ELAINE MCCARTHY
Credential	:
Telephone Number	:	978-975-7530

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	12/30/2008

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