MEDICARE: PALMETTO OPEN MRI 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1912219098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO OPEN MRI INC

Provider Business Mailing Address
First Line	:	3146 CORAL WAY
Second Line	:	SUITE # 100
City	:	MIAMI
State	:	FL
Zip	:	33145-3210
Country	:	US
Telephone Number	:	305-448-6841
Fax Number	:	305-448-6842

Provider Business Practice Location Address
First Line	:	3146 CORAL WAY
Second Line	:	SUITE # 100
City	:	MIAMI
State	:	FL
Zip	:	33145-3210
Country	:	US
Telephone Number	:	305-448-6841
Fax Number	:	305-448-6842

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEJANDRO E XIQUES
Credential	:
Telephone Number	:	305-448-6841

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	07/06/2010

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