MEDICARE: MIRIAM DIAGNOSTIC AND SERVICE 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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	HCC9257	FL

General Provider Information

NPI Number	:	1932485901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRIAM DIAGNOSTIC AND SERVICE INC

Provider Business Mailing Address
First Line	:	7822 SW 128TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4275
Country	:	US
Telephone Number	:	786-328-5203
Fax Number	:	305-433-4090

Provider Business Practice Location Address
First Line	:	7822 SW 128TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4275
Country	:	US
Telephone Number	:	786-328-5203
Fax Number	:	305-433-4090

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MIRIAM C REYES
Credential	:
Telephone Number	:	786-328-5203

Provider Enumeration Date	:	10/22/2011
Last Update Date	:	03/15/2012

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