Provider Demographics
NPI:1225592041
Name:CENTRAL FLORIDA RADIOLOGY LLC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA RADIOLOGY LLC
Other - Org Name:STANDUP MRI OF BREVARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-409-9990
Mailing Address - Street 1:PO BOX 411145
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32941-1145
Mailing Address - Country:US
Mailing Address - Phone:321-831-1111
Mailing Address - Fax:321-831-1212
Practice Address - Street 1:STANDUP MRI OF BREVRD
Practice Address - Street 2:6023 FARCENDA PLACE - SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7340
Practice Address - Country:US
Practice Address - Phone:321-409-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty