Provider Demographics
NPI:1588985535
Name:INMED DIAGNOSTIC SERVICES OF CENTRAL FLORIDA LLC
Entity type:Organization
Organization Name:INMED DIAGNOSTIC SERVICES OF CENTRAL FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-510-3704
Mailing Address - Street 1:2400 E COMMERCIAL
Mailing Address - Street 2:SUITE 826
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4054
Mailing Address - Country:US
Mailing Address - Phone:954-510-3700
Mailing Address - Fax:954-510-2649
Practice Address - Street 1:1503 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4065
Practice Address - Country:US
Practice Address - Phone:407-847-8864
Practice Address - Fax:407-847-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLET030AMedicare PIN