Provider Demographics
NPI:1427288067
Name:MIDTOWN IMAGING LLC
Entity type:Organization
Organization Name:MIDTOWN IMAGING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-964-8414
Mailing Address - Street 1:7400 SW 87TH AVE
Mailing Address - Street 2:SUITE 120B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5458
Mailing Address - Country:US
Mailing Address - Phone:305-595-4425
Mailing Address - Fax:305-595-1355
Practice Address - Street 1:7400 SW 87TH AVE
Practice Address - Street 2:SUITE 120B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5458
Practice Address - Country:US
Practice Address - Phone:305-595-4425
Practice Address - Fax:305-595-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology