Provider Demographics
NPI:1124289335
Name:COMPLETE DIAGNOSTIC IMAGING CENTER
Entity type:Organization
Organization Name:COMPLETE DIAGNOSTIC IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILHELM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-597-4338
Mailing Address - Street 1:11307 CORTEZ BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5407
Mailing Address - Country:US
Mailing Address - Phone:352-597-4338
Mailing Address - Fax:352-597-5882
Practice Address - Street 1:11307 CORTEZ BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5407
Practice Address - Country:US
Practice Address - Phone:352-597-4338
Practice Address - Fax:352-597-5882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography