Provider Demographics
NPI:1033292891
Name:MID FLORIDA RADIOLOGY CENTERS P.A
Entity Type:Organization
Organization Name:MID FLORIDA RADIOLOGY CENTERS P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:VERMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-775-1612
Mailing Address - Street 1:955 TOWN CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8255
Mailing Address - Country:US
Mailing Address - Phone:386-775-1612
Mailing Address - Fax:386-775-1289
Practice Address - Street 1:955 TOWN CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8255
Practice Address - Country:US
Practice Address - Phone:386-775-1612
Practice Address - Fax:386-775-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME753322085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID