| Entity Name: | INDIAN RIVER MRI, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 09 Jun 1995 (30 years ago) |
| Document Number: | P95000044634 |
| FEI/EIN Number | 650588733 |
| Address: | 1850 37TH STREET, VERO BEACH, FL, 32960, US |
| Mail Address: | 1850 37TH STREET, VERO BEACH, FL, 32960, US |
| ZIP code: | 32960 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215049614 | 2006-08-31 | 2010-05-11 | 1850 37TH ST, VERO BEACH, FL, 329604856, US | 1850 37TH ST, VERO BEACH, FL, 329604856, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 772-562-3030 |
| Fax | 7727780766 |
Authorized person
| Name | MR. RONALD COOPER |
| Role | PRESIDENT/OWNER |
| Phone | 7725623030 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | ME45770 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| License Number | HCC5552 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS |
| Number | V2952 |
| Issuer | BCBS PROVIDER NUMBER |
| Number | V2952 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| COOPER RONALD | Agent | 1850 37TH STREET, VERO BEACH, FL, 32960 |
| Name | Role | Address |
|---|---|---|
| COOPER RONALD | President | 1850 37th street, vero beach, FL, 32960 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2004-02-26 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 500000048335 |
| NAME CHANGE AMENDMENT | 1997-04-10 | INDIAN RIVER MRI, INC. | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
