1184860041 NPI number — MIAMI INTERNATIONAL DIAGNOSTICS INC

Table of content: (NPI 1184860041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184860041 NPI number — MIAMI INTERNATIONAL DIAGNOSTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIAMI INTERNATIONAL DIAGNOSTICS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184860041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 530543
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI SHORES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33153-0543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-654-5221
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 NW 170TH ST
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
NORTH MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33169-5521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-654-5221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/24/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GROPPER
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER/SOLE SHAREHOLDER
Authorized Official Telephone Number:
305-654-5221

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)