Provider Demographics
NPI:1275639767
Name:ALTAMONTE SPRINGS DIAGNOSTIC IMAGING INC
Entity Type:Organization
Organization Name:ALTAMONTE SPRINGS DIAGNOSTIC IMAGING INC
Other - Org Name:MID FLORIDA IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:I
Authorized Official - Last Name:LANDAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-482-5253
Mailing Address - Street 1:1150 S. SEMORAN BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-1424
Mailing Address - Country:US
Mailing Address - Phone:407-482-5253
Mailing Address - Fax:407-482-5254
Practice Address - Street 1:195 S. WESTMONTE DR
Practice Address - Street 2:SUITE 1118
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-4219
Practice Address - Country:US
Practice Address - Phone:407-786-5877
Practice Address - Fax:407-786-5803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTAMONTE SPRINGS DIAGNOSTIC IMAGING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-15
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC41732085R0202X
2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2219OtherBCBS PROVIDER NUMBER