Provider Demographics
NPI:1588975213
Name:SOUTHWEST FLORIDA REGIONAL IMAGING II LLC
Entity type:Organization
Organization Name:SOUTHWEST FLORIDA REGIONAL IMAGING II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KATZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-815-1988
Mailing Address - Street 1:329 E OLYMPIA AVE
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3833
Mailing Address - Country:US
Mailing Address - Phone:941-637-9729
Mailing Address - Fax:941-637-3873
Practice Address - Street 1:2852 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5125
Practice Address - Country:US
Practice Address - Phone:941-637-9729
Practice Address - Fax:941-637-3873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002995400Medicaid
FLDH230AMedicare UPIN