1033145669 NPI number — LCM IMAGING INC

Table of content: (NPI 1033145669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033145669 NPI number — LCM IMAGING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LCM 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:
1033145669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
607 W MARTIN LUTHER KING JR BLVD,
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33603-3453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-463-4444
Provider Business Mailing Address Fax Number:
813-849-6349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6800 SOUTHPOINT PKWY
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-6257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-296-8998
Provider Business Practice Location Address Fax Number:
904-296-8997
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KEMP
Authorized Official First Name:
TIFFANY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
813-325-1389

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000659900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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