| Entity Name: | BEACHES OPEN MRI, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Jun 1999 (26 years ago) |
| Document Number: | L99000003501 |
| FEI/EIN Number | 650939085 |
| Address: | 8300 W. SUNRISE BLVD, PLANTATION, FL, 33322, US |
| Mail Address: | 8300 W. SUNRISE BLVD, PLANTATION, FL, 33322, US |
| ZIP code: | 33322 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063564672 | 2007-01-17 | 2012-01-24 | 350 10TH AVE S, JACKSONVILLE BEACH, FL, 322505136, US | 350 10TH AVE S, JACKSONVILLE BEACH, FL, 322505136, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 904-247-2220 |
| Fax | 9042472296 |
Authorized person
| Name | MR. MARK S. FRISK |
| Role | RADIOLOGIST |
| Phone | 9042472220 |
Taxonomy
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| License Number | 0700012919 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA PROVIDER # |
| Number | 2240835 |
| State | FL |
| Issuer | WELLCARE |
| Number | 38350 |
| State | FL |
| Issuer | BCBS PROVIDER # |
| Number | V2353 |
| State | FL |
| Name | Role |
|---|---|
| LEGALINC CORPORATE SERVICES INC. | Agent |
| Name | Role | Address |
|---|---|---|
| SPEED DARREN | Managing Member | 8300 W. SUNRISE BLVD, PLANTATION, FL, 33322 |
| Name | Role | Address |
|---|---|---|
| FIX THOMAS MD | Manager | 8300 W. SUNRISE BLVD, PLANTATION, FL, 33322 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2024-02-01 | No data | No data |
| LC STMNT OF RA/RO CHG | 2024-01-05 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
