Provider Demographics
NPI:1033145669
Name:LCM IMAGING INC
Entity Type:Organization
Organization Name:LCM IMAGING INC
Other - Org Name:ADVANCED DIAGNOSTIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-325-1389
Mailing Address - Street 1:607 W MARTIN LUTHER KING JR BLVD,
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3453
Mailing Address - Country:US
Mailing Address - Phone:813-463-4444
Mailing Address - Fax:813-849-6349
Practice Address - Street 1:6800 SOUTHPOINT PKWY
Practice Address - Street 2:SUITE 401
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6257
Practice Address - Country:US
Practice Address - Phone:904-296-8998
Practice Address - Fax:904-296-8997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHN501AMedicare UPIN