Provider Demographics
NPI:1699229641
Name:PRECISION MRI CENTER LLC
Entity type:Organization
Organization Name:PRECISION MRI CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS MACLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-266-4210
Mailing Address - Street 1:3500 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6809
Mailing Address - Country:US
Mailing Address - Phone:954-266-4210
Mailing Address - Fax:954-289-5948
Practice Address - Street 1:3500 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6809
Practice Address - Country:US
Practice Address - Phone:954-266-4210
Practice Address - Fax:954-289-5948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL14000167208OtherDOCUMENT NUMBER