Provider Demographics
NPI:1093763591
Name:INVERNESS MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:INVERNESS MEDICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-637-6100
Mailing Address - Street 1:2105 HWY 44 WEST
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-3805
Mailing Address - Country:US
Mailing Address - Phone:352-419-4818
Mailing Address - Fax:352-637-1034
Practice Address - Street 1:2105 STATE ROAD 44 W
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452
Practice Address - Country:US
Practice Address - Phone:352-419-4818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275125900Medicaid
FL275125900Medicaid
FLQ0387Medicare PIN
FLDF2783 RR MCRMedicare PIN