Provider Demographics
NPI:1588855027
Name:PHYSICIANS IMAGING -- LAKE CITY LLC
Entity type:Organization
Organization Name:PHYSICIANS IMAGING -- LAKE CITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-383-8800
Mailing Address - Street 1:404 NW HALL OF FAME DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4833
Mailing Address - Country:US
Mailing Address - Phone:386-487-3970
Mailing Address - Fax:386-487-3972
Practice Address - Street 1:404 NW HALL OF FAME DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4833
Practice Address - Country:US
Practice Address - Phone:386-487-3970
Practice Address - Fax:386-487-3972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7889261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology