1518911668 NPI number — FLORIDA RADIOLOGY CONSULTANTS P A

Table of content: (NPI 1518911668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518911668 NPI number — FLORIDA RADIOLOGY CONSULTANTS P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA RADIOLOGY CONSULTANTS P A
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:
1518911668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8791 CONFERENCE DR
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33919-5822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-331-5566
Provider Business Mailing Address Fax Number:
239-437-7499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2776 CLEVELAND AVE
Provider Second Line Business Practice Location Address:
DEPT. OF RADIOLOGY
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33901-5864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-331-5566
Provider Business Practice Location Address Fax Number:
239-377-4994
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KSAR
Authorized Official First Name:
JAMAL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
239-331-5566

Provider Taxonomy Codes

  • Taxonomy code: 2085N0904X , with the licence number:  NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: NA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: NA , 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: 262870800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262870815 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262870807 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262870808 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262870814 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262870816 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ5512 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 262870811 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262870805 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262870806 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262870809 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262870810 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262870813 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262870804 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38168 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 262870812 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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