Provider Demographics
NPI:1265509962
Name:FLORIDA RADIOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:FLORIDA RADIOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-767-5306
Mailing Address - Street 1:PO BOX 150505
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32715-0505
Mailing Address - Country:US
Mailing Address - Phone:407-767-0433
Mailing Address - Fax:407-767-0608
Practice Address - Street 1:2566 LEE RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1746
Practice Address - Country:US
Practice Address - Phone:407-303-1200
Practice Address - Fax:407-303-1213
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA RADIOLOGY ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-29
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00552Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER