Provider Demographics
NPI:1114245545
Name:ORLANDO OUTPATIENT RADIOLOGY SERVICES
Entity Type:Organization
Organization Name:ORLANDO OUTPATIENT RADIOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCROGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-630-6277
Mailing Address - Street 1:1471 CADES BAY AVE
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5301
Mailing Address - Country:US
Mailing Address - Phone:561-630-6277
Mailing Address - Fax:561-630-6062
Practice Address - Street 1:45 W CRYSTAL LAKE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4435
Practice Address - Country:US
Practice Address - Phone:561-630-6277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLN/A261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile