Basic Information
| Provider Information | |||||||||
| NPI: | 1508933235 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA RADIOLOGY MANAGEMENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 150340 | ||||||||
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| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327150340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077670433 | ||||||||
| FaxNumber: | 4077670608 | ||||||||
| Practice Location | |||||||||
| Address1: | 4200 SUN N LAKE BLVD | ||||||||
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| City: | SEBRING | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338721986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634023447 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MAY | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 4077675306 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085R0202X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.