MEDICARE: NATIONAL NUCLEAR CENTERS, 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	261Q00000X	Clinic/Center	HCC3753	FL
2	261QR0200X	Radiology Clinic/Center	HCCR3753	FL
3	261QR0208X	Mobile Radiology Clinic/Center	HCC8933	FL
4	293D00000X	Physiological Laboratory	HCC3753	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750377552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL NUCLEAR CENTERS, INC

Provider Business Mailing Address
First Line	:	4224 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021
Country	:	US
Telephone Number	:	954-966-3600
Fax Number	:	954-967-1962

Provider Business Practice Location Address
First Line	:	4224 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021
Country	:	US
Telephone Number	:	954-966-3600
Fax Number	:	954-967-1962

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANGEL L SOTO JR.
Credential	:
Telephone Number	:	954-966-3600

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	01/24/2018

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