| Diversity Mri Llc | |
|
801 S University Dr Ste K103a Plantation FL 33324-3367 | |
| (954) 905-7217 | |
| (954) 905-7217 |
| Full Name | Diversity Mri Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 801 S University Dr Ste K103a, Plantation, Florida |
| Authorized Official Name and Position | Joshua A Ruskin (OWNER) |
| Authorized Official Contact | 9543472242 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diversity Mri Llc 801 S University Dr Ste K103a Plantation FL 33324-3367 Ph: (954) 905-7217 | Diversity Mri Llc 801 S University Dr Ste K103a Plantation FL 33324-3367 Ph: (954) 905-7217 |
| NPI Number | 1346746179 |
|---|---|
| Provider Enumeration Date | 04/02/2018 |
| Last Update Date | 06/21/2024 |
| Medicare PECOS PAC ID | 6901262534 |
|---|---|
| Medicare Enrollment ID | O20230523003118 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346746179 | NPI | - | NPPES |
| 121391600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | L17000172498 (Florida) | Secondary |
| 261QM1200X | Clinic/center - Magnetic Resonance Imaging (mri) | L17000172498 (Florida) | Primary |
| Provider Name | Bruce A Rodan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073575858 PECOS PAC ID: 5597660159 Enrollment ID: I20031205000408 |
| Provider Name | Nicholas M Gutierrez |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457643033 PECOS PAC ID: 5294020939 Enrollment ID: I20180109000897 |
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