Provider Demographics
NPI:1992832646
Name:HIGHLANDS DIAGNOSTIC IMAGING CENTER, INC
Entity type:Organization
Organization Name:HIGHLANDS DIAGNOSTIC IMAGING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:C
Authorized Official - Last Name:BASILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-386-9469
Mailing Address - Street 1:PO BOX 151908
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33915-1908
Mailing Address - Country:US
Mailing Address - Phone:239-242-5237
Mailing Address - Fax:239-242-7274
Practice Address - Street 1:3642 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5453
Practice Address - Country:US
Practice Address - Phone:863-386-9469
Practice Address - Fax:863-386-9472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28131AMedicare ID - Type Unspecified