Provider Demographics
NPI:1184689127
Name:RADIOLOGY ASSOCIATES OF CENTRAL FLORIDA L L C
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF CENTRAL FLORIDA L L C
Other - Org Name:LAKE MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RISK MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-365-2583
Mailing Address - Street 1:734 N 3RD ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5285
Mailing Address - Country:US
Mailing Address - Phone:352-365-2583
Mailing Address - Fax:352-728-6749
Practice Address - Street 1:600 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5925
Practice Address - Country:US
Practice Address - Phone:352-787-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43346200Medicaid
FLK1941OtherMEDICARE
FL100952301Medicaid
FL100952301Medicaid