Provider Demographics
NPI:1063406304
Name:NEUROSKELETAL IMAGING LLC
Entity type:Organization
Organization Name:NEUROSKELETAL IMAGING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MNGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAUCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-409-9990
Mailing Address - Street 1:P.O. BOX 400
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5591
Mailing Address - Country:US
Mailing Address - Phone:321-409-9990
Mailing Address - Fax:321-956-2165
Practice Address - Street 1:255 N SYKES CREEK PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3518
Practice Address - Country:US
Practice Address - Phone:321-454-6335
Practice Address - Fax:321-956-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27453990Medicaid
FL27453990Medicaid