Provider Demographics
NPI:1225096936
Name:FLORIDA DIAGNOSTIC IMAGING CENTER INC
Entity Type:Organization
Organization Name:FLORIDA DIAGNOSTIC IMAGING CENTER INC
Other - Org Name:PANAMA CITY OPEN MRI & IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RAIF
Authorized Official - Middle Name:
Authorized Official - Last Name:ERIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-713-7519
Mailing Address - Street 1:1642 WESTGATE CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8195
Mailing Address - Country:US
Mailing Address - Phone:615-713-7519
Mailing Address - Fax:
Practice Address - Street 1:2525 MARTIN LUTHER KING JR. BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4414
Practice Address - Country:US
Practice Address - Phone:850-873-6900
Practice Address - Fax:850-873-6902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2021-06-14
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
FL470000877OtherRR MEDICARE
FLSG076081OtherVISTA SUNRISE
FL262856200Medicaid
FL7501697OtherAETNA
FLV2704OtherBCBS FLORIDA
FL2050236OtherUNITED HEALTHCARE
FLSG076081OtherVISTA SUNRISE
FLSG076081OtherVISTA SUNRISE