1861598310 NPI number — ALTAMONTE SPRINGS DIAGNOSTIC IMAGING INC

Table of content: (NPI 1861598310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861598310 NPI number — ALTAMONTE SPRINGS DIAGNOSTIC IMAGING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTAMONTE SPRINGS 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:
6
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:
1861598310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 S. SEMORAN BLVD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32807-1424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-482-5253
Provider Business Mailing Address Fax Number:
407-482-5254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6342 W. COLONIAL DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32818-7859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-523-0411
Provider Business Practice Location Address Fax Number:
407-523-0412
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LANDAU
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
I
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
407-482-5253

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: HCC4170 , 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: V2788 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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