Provider Demographics
NPI:1235197930
Name:FLORIDA DIAGNOSTIC IMAGING CENTER INC
Entity Type:Organization
Organization Name:FLORIDA DIAGNOSTIC IMAGING CENTER INC
Other - Org Name:PENSACOLA OPEN MRI
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 1:4511 N DAVIS HWY
Practice Address - Street 2:SUITE 1-B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2720
Practice Address - Country:US
Practice Address - Phone:850-484-8454
Practice Address - Fax:850-484-7754
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
FL068972OtherVISTA MEDICAID
FL470000877OtherRAILROAD MEDICARE
FL7143079OtherAETNA
FL55301OtherBCBS ALABAMA
FL262856202Medicaid
FLV2193OtherBCBS