Organization
PEMBROKE PINES MRI INC
Active
Other names
DPI of Pembroke Pines
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HOWARD STEPHAN DEKKERS (CEO)
(954) 566-4551
Entity
Organization
Contact information
Practice address
10950 PINES BLVD, PEMBROKE PINES, FL 33026-5216
(954) 566-4551
(954) 566-4565
Mailing address
PO BOX 5206, FT LAUDERDALE, FL 33310-5206
(954) 566-4551
(954) 566-4565
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7555441
AETNA
FL
01
—
V2624
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/11/2006
Last updated
05/19/2008
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