Provider Demographics
NPI:1841298361
Name:TRANSFLORIDA MOBILE DIAGNOSTIC SERVICES LC
Entity type:Organization
Organization Name:TRANSFLORIDA MOBILE DIAGNOSTIC SERVICES LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PYLES
Authorized Official - Suffix:
Authorized Official - Credentials:R T (R)
Authorized Official - Phone:888-929-2224
Mailing Address - Street 1:805 S ORLANDO AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4869
Mailing Address - Country:US
Mailing Address - Phone:888-929-2224
Mailing Address - Fax:877-972-9327
Practice Address - Street 1:805 S ORLANDO AVE
Practice Address - Street 2:SUITE F
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4869
Practice Address - Country:US
Practice Address - Phone:888-929-2224
Practice Address - Fax:877-972-9327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3857293D00000X, 335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630001602OtherRAILROAD MEDICARE
FL510018600Medicaid
FLP00237663OtherRAILROAD MEDICARE
FL105409OtherWELLCARE HMO
FL16-00698OtherEVERCARE HMO
FLW9927Medicare ID - Type UnspecifiedPORTABLE XRAY
FL105409OtherWELLCARE HMO