Provider Demographics
NPI:1144378993
Name:ALTAMONTE SPRINGS DIAGNOSTIC IMAGING INC
Entity Type:Organization
Organization Name:ALTAMONTE SPRINGS DIAGNOSTIC IMAGING INC
Other - Org Name:PREMIER MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:I
Authorized Official - Last Name:LANDAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-482-5253
Mailing Address - Street 1:601 N CONGRESS AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4703
Mailing Address - Country:US
Mailing Address - Phone:561-921-0922
Mailing Address - Fax:561-921-0923
Practice Address - Street 1:601 N. CONGRESS AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4621
Practice Address - Country:US
Practice Address - Phone:561-921-0922
Practice Address - Fax:561-921-0923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTAMONTE SPRINGS DIAGNOSTIC IMAGING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-08
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
FL4645261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269651700Medicaid
FLU3096Medicare ID - Type Unspecified