Provider Demographics
NPI:1457927469
Name:EAST CENTRAL FLORIDA OUTPATIENT IMAGING, LLC
Entity type:Organization
Organization Name:EAST CENTRAL FLORIDA OUTPATIENT IMAGING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-274-7118
Mailing Address - Street 1:PO BOX 678454
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3048 S ATLANTIC AVE STE 102
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH SHORES
Practice Address - State:FL
Practice Address - Zip Code:32118-6102
Practice Address - Country:US
Practice Address - Phone:386-274-7118
Practice Address - Fax:386-276-6173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CENTRAL FLORIDA OUTPATIENT IMAGING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-01
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty