Provider Demographics
NPI:1306965884
Name:PALMETTO OPEN MRI INC
Entity type:Organization
Organization Name:PALMETTO OPEN MRI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:R
Authorized Official - Last Name:XIQUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-448-6841
Mailing Address - Street 1:2150 WEST 68 ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-818-6868
Mailing Address - Fax:305-818-6872
Practice Address - Street 1:2150 WEST 68 ST
Practice Address - Street 2:SUITE #102
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-818-6868
Practice Address - Fax:305-818-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E5557Medicare ID - Type Unspecified