Provider Demographics
NPI:1538375936
Name:ROSE MED DIAGNOSTIC CENTER INC
Entity type:Organization
Organization Name:ROSE MED DIAGNOSTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NILDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-242-1160
Mailing Address - Street 1:1235 N KROME AVE
Mailing Address - Street 2:SUITE R
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4204
Mailing Address - Country:US
Mailing Address - Phone:305-242-1160
Mailing Address - Fax:305-242-1161
Practice Address - Street 1:1235 N KROME AVE
Practice Address - Street 2:SUITE R
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4204
Practice Address - Country:US
Practice Address - Phone:305-242-1160
Practice Address - Fax:305-242-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC2775261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266069500Medicaid
FLK2074Medicare PIN