Provider Demographics
NPI:1255649711
Name:EDXO IMAGING HEALTH GROUP LLC
Entity Type:Organization
Organization Name:EDXO IMAGING HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:XOMIR
Authorized Official - Middle Name:L
Authorized Official - Last Name:NADAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-878-0235
Mailing Address - Street 1:202 MAGELLAN CIR
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-5702
Mailing Address - Country:US
Mailing Address - Phone:239-878-0235
Mailing Address - Fax:
Practice Address - Street 1:202 MAGELLAN CIR
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-5702
Practice Address - Country:US
Practice Address - Phone:239-878-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty