Provider Demographics
NPI:1124669833
Name:REX DIAGNOSTIC AND IMAGING
Entity type:Organization
Organization Name:REX DIAGNOSTIC AND IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RENAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-277-6414
Mailing Address - Street 1:6245 MIRAMAR PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3964
Mailing Address - Country:US
Mailing Address - Phone:561-990-3434
Mailing Address - Fax:561-529-4522
Practice Address - Street 1:6245 MIRAMAR PKWY STE 101
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3964
Practice Address - Country:US
Practice Address - Phone:561-990-3434
Practice Address - Fax:561-529-4522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REX DIAGNOSTIC AND IMAGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL427517OtherORTHOPEDIS