1356305767 NPI number — FLORIDA DIAGNOSTIC IMAGING INC

Table of content: (NPI 1356305767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356305767 NPI number — FLORIDA DIAGNOSTIC IMAGING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA DIAGNOSTIC IMAGING INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356305767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5201 BABCOCK ST NE
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
PALM BAY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32905-4637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-676-5323
Provider Business Mailing Address Fax Number:
321-951-9253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5201 BABCOCK ST NE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
PALM BAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32905-4637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-676-5323
Provider Business Practice Location Address Fax Number:
321-951-9253
Provider Enumeration Date:
04/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LANDIS
Authorized Official First Name:
IAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
321-676-5323

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  HCC5282 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102370 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 40016 . This is a "FLORIDIANCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: FDA 155978 . This is a "EMBRACED PROGRAM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2489 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1209448 . This is a "FIRST HEALTH/MAIL HANDLER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 16-00554 . This is a "UNITEDHEALTHCARE MEDIPASS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 17030 . This is a "STAYWELL/WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 288660 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1488395 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 17030 . This is a "HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: OS0004065 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0782103 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 8208068 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 061752100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com